目的：观察腰丛神经阻滞用于老年全髋关节置换术患者的临床效果。方法择期拟在全身麻醉下行单侧全髋关节置换术老年患者60例，ASA 分级Ⅰ—Ⅱ级，按随机数字表法将患者分为对照组（C 组）和腰丛神经阻滞组（L 组），每组30例。2组患者均选择气管插管全身麻醉。L 组于麻醉诱导前在神经刺激器引导下行腰丛神经阻滞，给予0．5％罗哌卡因30 mL；C 组不给予任何处理。术毕均使用舒芬太尼自控静脉镇痛，维持 VAS 评分≤3分，当 VAS 评分＞3分时，静脉注射酮咯酸氨丁三醇。分别于入室后（T0）、手术开始即刻（T1）、10 min（T2）、30 min （T3）及术毕（T4）时记录患者 HR、MAP 和 SpO2；分别于术后2、4、8、12、24和48 h 时行 BCS 舒适度评分，记录患者术后24 h 舒芬太尼用量、酮咯酸氨丁三醇使用率及术后不良反应发生情况。结果与 T0时比较，C 组 T1—T4时MAP 升高、HR 增快（P ＜0．05），L 组各时点 MAP 和 HR 差异无统计学意义（P ＞0．05）；与 C 组比较，L 组 T1—T4时 MAP 和 HR 降低，术后各时点 BCS 舒适度评分升高，24 h 舒芬太尼用量及酮咯酸氨丁三醇使用率减少（P ＜0．05），SpO2及不良反应发生率差异无统计学意义（P ＞0．05）。结论腰丛神经阻滞复合全身麻醉用于老年全髋关节置换手术血流动力学更稳定，且可提高患者术后镇痛效果，节俭术后阿片类镇痛药的用量。%ABSTRACT:Objective To observe the clinical efficacy of lumbar plexus block in elderly patients undergoing total hip arthroplasty.Methods Sixty ASA Ⅰ-Ⅱ patients scheduled for elective total hip arthroplasty under general anesthesia with tracheal intubation were randomly divided into two groups,with 30 patients in each group.The patients in group L received lumbar plexus block guided by nerve stimulator with 30 mL of 0.5% ropivacaine before anesthesia induction.The pa-tients in group C received no treatment.Patients were given patient-controlled intravenous analge-sia(PCIA)with sufentanil after surgery.The VAS score was maintained at less than or equal to 3.If VAS score was greater than 3,patients were given intravenous injection of ketorolac tromethamine.The heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SpO2 ) were recorded after admission to operating room(T0 ),immediately after the beginning of surgery (T1 ),10 minutes after the beginning of surgery(T2 ),30 minutes after the beginning of surgery (T3 ),and at the end of surgery(T4 ).The Bruggman comfort score(BCS)was recorded 2,4,8,12, 24 and 48 hours after operation.The consumption of sufentanil within 24 hours after operation,usage of ketorolac tromethamine and postoperative adverse reactions were observed in all pa-tients.Results Compared with T0 ,MAP and HR significantly increased at T1-T4 in group C(P <0.05).No significant differences were found among different time points in group L(P >0.05). Compared with group C,MAP and HR decreased,BCS increased and sufentanil consumption and ketorolac tromethamine usage reduced in group L after operation(P <0.05).There were no sig-nificant differences in the SpO2 and postoperative adverse reactions between group C and group L (P >0.05).Conclusion Lumbar plexus block combined with general anesthesia can stabilize the hemodynamics,improve the postoperative analgesia and reduce the dosage of opioid analgesics in elderly patients undergoing total hip arthroplasty.
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机译：后路腰丛神经阻滞用于全髋关节置换术后镇痛：0.5％布比卡因与肾上腺素和0.5％罗哌卡因后路腰丛神经阻滞用于全关节置换术后镇痛的对比研究de la cadera：0.5％布比卡因与肾上腺素和0.5％罗哌卡因后路腰椎丛阻滞在全髋关节置换术后镇痛中的比较研究：0.5％布比卡因与肾上腺素和0.5％罗哌卡因的对照研究
