王传福

摘要：目的  探討外周神经阻滞在髋关节置换术中的效果及对围术期氧化应激反应的影响。方法  选取2018年1月～2019年6月我院收治的髋关节置换术患者85例，按照随机数表法分为对照组42例和观察组43例。对照组采用全身麻醉，观察组采用外周神经阻滞，比较两组一般情况（麻醉起效时间、舒芬太尼用量、PACU停留时间、术后住院时间）、围术期氧化应激指标[C反应蛋白（CRP）、皮质醇（COR）、去甲肾上腺素（NE）水平]及术后并发症发生情况。结果  两组PACU停留时间、术后住院时间比较[（38.76±19.31）min vs（40.15±20.27）min]、[（12.86±3.34）d vs（13.42±3.67）d]，差异无统计学意义（P>0.05）;观察组麻醉起效时间、舒芬太尼用量少于对照组[（5.64±2.88）min vs（9.49±3.52）min]、[（12.05±4.53）μg vs（32.38±6.79）μg]，差异有统计学意义（P<0.05）。观察组手术30 min、手术结束时、术后24 h CRP、COR低于对照组，差异有统计学意义（P<0.05）;观察组手术30 min、手术结束时NE高于对照组，术后24 h NE水平低于对照组，差异有统计学意义（P<0.05）;观察组术后并发症发生率为20.93%，低于对照组的42.86%，差异有统计学意义（P<0.05）。结论  外周神经阻滞用于髋关节置换术中能够减少舒芬太尼用量，缩短麻醉起效时间，减小氧化应激反应，降低术后并发症。

关键词：髋关节置换术;外周神经阻滞;氧化应激反应

中图分类号：R614.4                                  文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2020.15.030

文章编号：1006-1959（2020）15-0100-03

Abstract：Objective  To investigate the effect of peripheral nerve block in hip arthroplasty and its influence on perioperative oxidative stress. Methods  A total of 85 hip replacement patients admitted to our hospital from January 2018 to June 2019 were selected and divided into a control group of 42 cases and an observation group of 43 cases according to the random number table method. The control group was given general anesthesia， and the observation group was given peripheral nerve block. The two groups were compared with general conditions （anesthesia onset time， sufentanil dosage， PACU stay time， postoperative hospital stay）， perioperative oxidative stress indicators [C Reactive protein （CRP）， cortisol （COR）， norepinephrine （NE） levels] and postoperative complications.Results  Comparison of PACU stay time and postoperative hospital stay [（38.76±19.31） min vs （40.15±20.27） min]， [（12.86±3.34）d vs （13.42±3.67）d]， the difference was not statistically significant （P>0.05）; The onset time of anesthesia and the dosage of sufentanil in the observation group were less than those in the control group [（5.64±2.88） min vs （9.49±3.52） min]， [（12.05±4.53） μg vs （32.38±6.79） μg]， the difference was statistically significant （P<0.05）. The CRP and COR of the observation group were lower than those of the control group at 30 min after the operation， at the end of the operation， and at 24 h after the operation，the difference was statistically significant （P<0.05）; The NE level of the observation group was higher than that of the control group at 30 min after the operation and the end of the operation， and the NE level at 24 h after the operation was lower than that of the control group，the difference was statistically significant （P<0.05）; the postoperative complication rate of the observation group was 20.93%， which was low compared with 42.86% of the control group， the difference was statistically significant （P<0.05）.Conclusion  Peripheral nerve block used in hip replacement surgery can reduce the amount of sufentanil， shorten the onset time of anesthesia， reduce oxidative stress， and reduce postoperative complications.

Key words：Hip replacement surgery;Peripheral nerve block;Oxidative stress response

髋关节置换术（hip replacement）是治疗髋关节病变、髋关节骨折的重要方法，其常用的麻醉方法有全身静脉麻醉、椎管内麻醉等，但易造成严重的氧化应激反应，增加手术风险[1-3]。外周神经阻滞具有穿刺创伤小、对血流动力学影响小的优势，对不适宜全麻及椎管内麻醉的患者同样适用[4]。既往研究表明[5]，高龄股骨颈骨折手术患者采用腰丛联合骶旁坐骨神经阻滞对患者的心肺功能无明显影响，麻醉效果确切，术后疼痛轻。另有研究显示[6]，髋关节置换术患者采用外周神经阻滞较全身麻醉能够更好地改善其早期预后。氧化应激是手术患者常见的一种体内氧化与抗氧化作用失衡反应，倾向于氧化，其可增加患者手术及麻醉风险[7]。但尚未见关于外周神经阻滞对髋关节置换术患者围术期氧化应激反应影响的报道。基于……