“沙漏征”髂筋膜-骶丛阻滞联合全身麻醉在老年全髋关节置换术中应用

Application of "Hourglass Sign" iliofascial-sacral plexus block combined with general anesthesia in elderly patients undergoing total hip arthroplasty

摘要:

目的 分析“沙漏征”髂筋膜-骶丛阻滞联合全身麻醉在老年全髋关节置换术（THA）中的应用效果。方法 选取2022年1月—2024年1月于中国人民解放军联勤保障部队第九〇四医院行THA术的83例老年患者，按信封法将其分为对照组（40例）与观察组（43例）。对照组采取全身麻醉，观察组在对照组基础上联合“沙漏征”髂筋膜-骶丛阻滞。比较两组麻醉效果。结果 观察组术中出血量较对照组更少，术后疼痛缓解更快，应激指标改善更显著（P <0.05），自控镇痛泵按压次数及补救镇痛药物使用量均低于对照组（P <0.05）。两组术后不同时间点血流动力学水平均较术前有所波动，但观察组整体变化更趋平稳（P <0.05）。术后两组视觉模拟评分法（VAS）评分较术前均显著下降（P <0.05），且观察组VAS评分更低（P <0.05）。观察组术后应激指标下降幅度更大（P <0.05）。观察组并发症发生率与对照组比较，差异无统计学意义（P >0.05）。结论 采取“沙漏征”髂筋膜-骶丛阻滞联合全身麻醉效果显著，可有效维持血流动力学稳定，减少应激反应，减轻患者疼痛程度，不良反应发生率较低。

Abstract:

Objective To analyze the application effect of "Hourglass Sign" iliofascial-sacral plexus block combined with general anesthesia in elderly patients undergoing total hip arthroplasty (THA).Methods A total of 83 elderly patients who underwent THA in The 904th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2022 to January 2024 were selected and divided into two groups according to the envelope method. The control group (n = 40) received general anesthesia, and the observation group (n = 43) received "Hourglass Sign" iliofascial-sacral plexus block combined with general anesthesia. The anesthetic effects of the two groups were compared.Results Compared with the control group, the observation group had less intraoperative blood loss, faster postoperative pain relief, more significant improvement in stress indicators, fewer patient-controlled analgesia pump presses and lower rescue analgesic dosage (P < 0.05). Hemodynamics fluctuated at different time points postoperatively compared with preoperatively in both groups, but the overall changes in the observation group were more stable (P < 0.05). Postoperative Visual Analog Scale (VAS) scores decreased significantly in both groups compared with preoperative scores (P < 0.05), with lower scores in the observation group (P < 0.05). The observation group had a greater decrease in postoperative stress indicators (P < 0.05). There was no statistically significant difference in the incidence of complications between the observation group and the control group (P > 0.05).Conclusion The combination of "Hourglass Sign" iliofascial-sacral plexus block and general anesthesia has a significant effect. It can effectively maintain hemodynamic stability, reduce stress responses, alleviate the degree of pain in patients, with a low incidence of adverse reactions.