全髋关节置换术中星状神经节阻滞联合乌拉地尔静注的控制性降压效果观察

发布时间：2018-08-03 12:58

【摘要】：目的探讨超声引导下行星状神经节阻滞(SGB)联合乌拉地尔静注对全髋关节置换术患者控制性降压的效果。方法拟行全身麻醉下全髋关节置换术的患者60例,采用随机数字表法分为U组和SU组各30例。两组手术均采用全身麻醉,以咪唑安定、芬太尼、异丙酚、维库溴铵进行麻醉诱导,以异丙酚、芬太尼和维库溴铵维持麻醉。SU组在超声引导下以1%利多卡因行SGB,SGB成功后开始手术;两组均于手术开始时静注盐酸乌拉地尔5~10 mg控制性降压,使平均动脉压(MAP)达到60~65 mm Hg。记录术中异丙酚、芬太尼及乌拉地尔的用量、术中出血量、输液量及异体输血情况,记录手术时间、清醒时间及拔管时间。分别于入室(T_0)、手术开始时(T_1)、置入人工髋关节后(T_2)、手术结束时(T_3)、手术结束后3 h(T4)行血气分析,测定颈内静脉球血氧饱和度(SjvO2),计算桡动脉-颈内静脉球部血氧含量差(Da-jv O2)和脑氧摄取率(CEO2),记录收缩压(SBP)、舒张压(DBP)、MAP、心率(HR)。结果两组患者麻醉均顺利,未发生严重并发症,术中出血量少,术中未输注异体血。SU组术中未出现神经阻滞相关并发症。与U组相比,SU组术中乌拉地尔、异丙酚及芬太尼用量减少,清醒时间、拔管时间缩短(P均0.05)。U组T_1、T_2时点SBP、DBP、MAP较T_0时点降低(P均0.05),SU组T_1、T_2、T_3时点SBP、DBP、MAP较T_0时点降低(P均0.05),U组T_3时点SBP、DBP、MAP高于SU组(P均0.05)。U组T_2、T_3时点SjvO2较T_0时点降低,Da-jv O2、CEO2升高(P均0.05)。U组T_2、T_3时点SjvO2低于SU组,Da-jv O2和CEO2高于SU组(P均0.05)。结论超声引导下SGB联合乌拉地尔用于全髋关节置换术患者控制性降压可减少术中乌拉地尔和麻醉药用量,减少术中出血量,降压效果平稳,并可改善脑氧供需平衡,缩短麻醉恢复时间,较单用乌拉地尔效果更好。
[Abstract]:Objective to investigate the effect of planetary ganglion block (SGB) combined with urapidil on controlled hypotension in patients undergoing total hip arthroplasty (THR). Methods 60 patients with total hip replacement under general anesthesia were randomly divided into U group and Su group. Both groups were anesthetized with midazolam fentanyl propofol vecuronium and propofol. Fentanyl and vecuronium maintenance anesthesia were performed on SGBSGB under the guidance of ultrasound in the SU group, and the two groups were given urapidil hydrochloride 510mg for controlled hypotension at the beginning of the operation. The mean arterial pressure (MAP) reached 60mm / 65mm / g. The dosage of propofol, fentanyl and urapidil, intraoperative blood loss, transfusion volume and allogeneic blood transfusion were recorded. The time of operation, waking and extubation were recorded. Blood gas analysis was performed at the end of operation (T _ 3), at the beginning of operation (T _ (1), after insertion of artificial hip (T _ 2), at the end of operation (T _ (3), and at 3 h (T _ (4) after operation. The blood oxygen saturation (SjvO2) of internal jugular bulb was measured, the difference of blood oxygen content (Da-jv O 2) and cerebral oxygen uptake rate (CEO2) between radial artery and internal jugular vein were calculated. The systolic blood pressure (SBP),) and diastolic blood pressure (DBP) MAPP) were recorded. The heart rate of (HR). Was recorded. Results the anesthesia of the two groups was smooth, no serious complications occurred, the amount of intraoperative bleeding was less, and there were no nerve block related complications during the operation in the SU group without transfusion of allogeneic blood. The dosage of urapidil, propofol and fentanyl decreased and the waking time in SU group was lower than that in U group. The time of extubation was shortened (P 0.05). The map of SBP0 / T _ 2 in group T _ 1 / T _ 2 was lower than that in T _ 0 (P 0.05). (P) 0.05) in group T _ (1) and T _ (2) T _ (3), the value of map in group T _ (3) was lower than that in group T _ (0) (P < 0.05). In group U, it was higher than that in group T _ (2) (P = (0.05). In group U, it was lower than that in group T _ (0) (P < 0.05). In group U, the value of Da-jv _ 2o _ (2) CEO _ (2) was higher than that in group T _ (0). In U group, there was a decrease in Da-jv _ 2O _ (2) CEO _ 2 (P < 0.05). The SjvO2 at point was lower than that in Su group (P < 0. 05). The level of Da-jvO2 and CEO2 in Su group was higher than that in Su group (P < 0. 05). Conclusion Ultrasound-guided SGB combined with urapidil can reduce the dosage of urapidil and anesthetics in total hip arthroplasty, reduce the amount of intraoperative bleeding, reduce blood pressure, and improve the balance of cerebral oxygen supply and demand. It was better to shorten the recovery time of anesthesia than to use urapidil alone.
【作者单位】：河南大学淮河医院;
【基金】：河南省级科技攻关计划项目(201404028)
【分类号】：R614.4

【参考文献】