超声引导下腰丛-坐骨神经阻滞对高龄髋关节置换术患者围术期氧化应激反应的影响

摘要

目的 探讨超声引导下腰丛-坐骨神经阻滞对高龄髋关节置换术患者围术期氧化应激反应的影响.方法 将79例行髋关节置换手术治疗的高龄患者分为2组.对照组行全麻,观察组在对照组基础上采用罗哌卡因进行腰丛神经和坐骨神经阻滞麻醉.比较2组围术期血流动力学指标、氧化应激反应指标;记录2组镇痛泵有效按压次数及不良反应发生例数.结果 麻醉前(T0)、切皮时(T1)及手术进行30 min(T2)、结束时(T3)、术后1 h(T4)时,对照组各项血流动力学指标均明显变化,T1时各指标值显著最低(P ＜0.05);观察组各项血流动力学指标未随时间变化而出现明显波动,各时间点差异无统计学意义(P＞ 0.05).T1～T4,2组血清C反应蛋白(CRP)、皮质醇(COR)水平随时间变化而显著增加(P ＜0.05);T2时,NE水平最低,T3～T6时显著增加(P ＜0.05);不同时期内,观察组围术期血流动力学指标值和氧化应激反应指标变化均显著小于对照组(P ＜0.05).与对照组比,观察组术后镇痛泵有效按压次数及不良反应发生例数显著较少(P ＜0.05).结论超声引导腰丛及坐骨神经阻滞在高龄股骨颈骨折患者髋关节置换术中具有较高的安全性,可更好地稳定血流动力学指标,抑制机体氧化应激反应,减少术后镇痛泵使用次数.%Objective To investigate the effect of ultrasound-guided lumbar plexus-sciatic nerve block on perioperative oxidative stress response in elderly patients with hip replacement. Methods A total of 79 elderly patients with hip replacement were divided into two groups. The control group was treated with general anesthesia, and the observation group was treated with ropivacaine for lumbar plexus-sciatic nerve block. The perioperative hemodynamics indexes and oxidative stress response indexes were compared between the two groups. The number of effective analgesic pump presses and the number of adverse reactions were recorded. Results At the time points of before anesthesia (T0), skin incision (T1), 30 minutes after operation (T2), at the end of operation (T3) and1 hour after operation (T4), the hemodynamic indexes of the control group changed significantly, and the levels of indexes at T1 were the lowest (P ＜ 0. 05). The hemodynamic indexes of the observation group did not change significantly with time, and there were no significant differences in indexes between each time point (P＞ 0. 05). The levels of serum C-reactive protein (CRP) and cortisol (COR) from T1 to T4 increased significantly with time in both groups (P ＜ 0. 05), norepinephrine (NE) level was the lowest at T2 and increased significantly from T3 to T6 (P ＜ 0. 05). The changes of hemodynamic indexes and oxidative stress indexes in observation group were significantly smaller than those in control group at different time points (P ＜ 0. 05). Compared with the control group, the number of effective analgesic pump presses and cases with adverse reactions in the observation group were significantly less than those in the control group (P ＜ 0. 05). Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block has a high safety in hip replacement for elderly patients with femoral neck fracture, which can better stabilize hemodynamic parameters, inhibit oxidative stress reaction and reduce the using number of analgesic pump after operation.