超声引导下骶竖脊肌平面复合骶丛阻滞联合全身麻醉对老年髋关节置换患者术中应激反应及术后恢复的影响

Effect of ultrasound-guided sacral erector spinae plane block combined with sacral plexus block with general anesthesia on intraoperative stress response and postoperative recovery in elderly patients undergoing hip arthroplasty

摘要:

目的 验证骶竖脊肌平面复合骶丛阻滞在老年髋关节置换术中镇痛效果的有效性，并分析其与经典全身麻醉相比，在术中对患者生命体征及术后短期恢复的影响差异。方法 选取2024年9月—2025年2月在中国人民解放军联勤保障部队第九二五医院接受骶竖脊肌平面复合骶丛阻滞联合全身麻醉进行髋关节置换术的80例老年患者作为联合组；回顾性分析2022年1月—2022年6月在中国人民解放军联勤保障部队第九二五医院采用经典全身麻醉方案完成同类手术的80例老年患者作为对照组。对比两组患者的镇痛效果及麻醉复苏情况。结果 两组患者T₀～T₆的平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）和血糖比较，结果 ①不同时间点MAP、HR、BIS和血糖比较，差异均有统计学意义（P <0.05）；②两组患者MAP、BIS比较，差异均无统计学意义（P >0.05），两组患者HR、血糖比较，差异均有统计学意义（P <0.05）；③两组患者MAP、HR和血糖变化趋势比较，差异均有统计学意义（P <0.05），其中对照组MAP、HR及血糖在不同时间点波动趋势更明显；两组患者BIS变化趋势比较，差异无统计学意义（P >0.05）。联合组患者离室时NRS评分和瑞芬太尼消耗量均低于对照组（P <0.05）。两组患者手术时间比较，差异无统计学意义（P >0.05）。联合组患者苏醒时间、脱离呼吸支持时间和意识恢复满意时间均短于对照组（P <0.05）。联合组复苏中并发症总发生率低于对照组（P <0.05）。结论 老年髋关节置换术患者应用骶竖脊肌平面复合骶丛阻滞联合全身麻醉，不仅能有效镇痛，还能维持术中循环功能稳定、减少应激，缩短麻醉复苏时间，降低并发症发生率，从而有助于患者的术后快速恢复。

Abstract:

Objective To verify the analgesic efficacy of sacral erector spinae plane block combined with sacral plexus block in elderly patients undergoing hip arthroplasty, and to analyze its differential impacts on intraoperative vital signs and short-term postoperative recovery compared with conventional general anesthesia.Methods Eighty elderly patients who received the combined sacral erector spinae plane and sacral plexus blocks along with general anesthesia for hip arthroplasty between September 2024 and February 2025 were assigned to the combination group. Another 80 elderly patients who underwent the same surgery under conventional general anesthesia between January 2022 and June 2022 were retrospectively analyzed as the control group. Analgesic outcomes and anesthesia recovery profiles were compared between the two groups.Results Comparisons of mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), and blood glucose at time points T₀ to T₆ yielded the following results: (1) Significant differences were observed in MAP, HR, BIS, and blood glucose across different time points (P < 0.05). (2) No significant intergroup differences were found in MAP and BIS (P > 0.05), whereas significant differences existed in HR and blood glucose (P < 0.05). (3) The trends of change in MAP, HR, and blood glucose differed significantly between the two groups (P < 0.05), with the control group exhibiting more pronounced fluctuations in these parameters over time. No significant difference was found in the trend of BIS change (P > 0.05). The combination group showed lower Numeric Rating Scale (NRS) scores upon leaving the post-anesthesia care unit (PACU) and lower total remifentanil consumption than the control group (P < 0.05). No significant difference was observed in operative time between the two groups (P > 0.05). The combination group had shorter time to emergence, time to liberation from respiratory support, and time to satisfactory recovery of consciousness than the control group (P < 0.05). The total incidence of complications during recovery was lower in the combination group (P < 0.05).Conclusion For elderly patients undergoing hip arthroplasty, the application of sacral erector spinae plane block combined with sacral plexus block and general anesthesia provides effective analgesia, maintains stable intraoperative circulatory function, attenuates stress response, shortens anesthesia recovery time, reduces the incidence of complications, and thereby facilitates rapid.