超声引导下腰丛神经阻滞联合快速骶丛神经阻滞及喉罩全身麻醉在老年全髋关节置换术中的应用

Use of ultrasound-guided anterior lumbar plexus block combined with rapid sacral plexus block and laryngeal mask general anesthesia in elderly patients undergoing total hip arthroplasty.

作者信息

Fang Zhen, Li Mengsi, Jiang Ting, Zhao Yan, Chang Lu

机构信息

Department of Anesthesiology, Lanxi People's Hospital Lanxi 321100, Zhejiang, China.

出版信息

Am J Transl Res. 2025 Apr 15;17(4):3189-3197. doi: 10.62347/PADU2071. eCollection 2025.

DOI:10.62347/PADU2071

PMID:40385033

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12082533/

Abstract

OBJECTIVES

To evaluate the effects of ultrasound-guided anterior lumbar plexus block combined with rapid sacral plexus block and laryngeal mask general anesthesia in elderly patients undergoing total hip arthroplasty (THA).

METHODS

This retrospective study involved 84 elderly patients, divided into two groups based on anesthesia method: control group (n=40) and observation group (n=44). Hemodynamics, including mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO) were compared between the two groups before anesthesia (T0), after induction of anesthesia (T1), immediately after skin incision (T2), and immediately after the end of surgery (T3). Preoperative and postoperative (1 day after surgery) levels of cortisol, blood glucose, norepinephrine, and adrenaline were compared between the two groups. Postoperative recovery time, laryngeal mask removal time, observer's assessment of alertness/sedation (OAA/S) score, and incidence of postoperative complications were also recorded.

RESULTS

From T1-T3, the MAP, HR, and SpO were significantly higher in the observation group than those of the control group (all <0.05). The anesthetic effect in the observation group was better than that of the control group (<0.05). At 1d after surgery, levels of cortisol, blood glucose, norepinephrine, and adrenaline increased in both groups, but they were lower in the observation groups than in the control group. The OAA/S score was lower in the observation group, and both postoperative recovery time and laryngeal mask removal time were shorter than those of the control group (all <0.05). Patients were further categorized into an orthostatic intolerance (OI) group (n=38) and a non-OI group (n=46) after THA. Factors influencing OI in elderly patients included BMI, decreased hemoglobin levels, and MFES score.

CONCLUSION

Ultrasound-guided anterior lumbar plexus block combined with rapid sacral plexus block and laryngeal mask general anesthesia provides a superior anesthesia effect and reduces postoperative complications in elderly patients undergoing THA.

摘要

目的

评估超声引导下腰丛神经阻滞联合快速骶丛神经阻滞及喉罩全身麻醉在老年全髋关节置换术（THA）患者中的效果。

方法

本回顾性研究纳入84例老年患者，根据麻醉方法分为两组：对照组（n = 40）和观察组（n = 44）。比较两组患者麻醉前（T0）、麻醉诱导后（T1）、皮肤切开即刻（T2）及手术结束即刻（T3）的血流动力学指标，包括平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO）。比较两组患者术前及术后（术后1天）的皮质醇、血糖、去甲肾上腺素和肾上腺素水平。记录术后恢复时间、喉罩拔除时间、观察者警觉/镇静评分（OAA/S）及术后并发症发生率。

结果

从T1至T3，观察组的MAP、HR和SpO均显著高于对照组（均P < 0.05）。观察组的麻醉效果优于对照组（P < 0.05）。术后1天，两组患者的皮质醇、血糖、去甲肾上腺素和肾上腺素水平均升高，但观察组低于对照组。观察组的OAA/S评分较低，术后恢复时间和喉罩拔除时间均短于对照组（均P < 0.05）。THA术后患者进一步分为体位性不耐受（OI）组（n = 38）和非OI组（n = 4）。影响老年患者OI的因素包括体重指数、血红蛋白水平降低和MFES评分。