| Objective:To observe the application of lumbar plexus nerve block in general anesthesia of total hip arthroplasty in elderly patients,and to explore the advantages of nerve block combined with laryngeal mask general anesthesia in elderly patients.Methods:90 elderly patients undergoing total hip arthroplasty admitted to the Affiliated Hospital of Hebei University from October 2019 to January 2021 were randomly divided into group C（combined spinal anesthesia）,group I（ultrasound-guided lumbar plexus nerve block combined with tracheal intubation general anesthesia）and group L（ultrasound-guided lumbar plexus nerve block combined with laryngeal mask general anesthesia）.The general conditions of patients in each group were statistically analyzed.Select 5min after entering the room（T0）,waist hard joint group C complete immediately,and I,L set of endotracheal tube or laryngeal mask placement（T1）,surgery（T2）,when cut a skin expansion when the pulp（T3）,prosthesis implantation（T4）,sew incision（T5）,group C never put off till tomorrow what you can turn and I,L set into the recovery room after removing the endotracheal tube or laryngeal mask（T6）of Heart rate（Heart Rate（HR）,Mean Arterial Pressure（MAP）and Surplus Pulse O2（Sp O2）.The changes of intraoperative blood loss,postoperative extubation time,movement time out of bed,discharge time,pharynx pain,nausea and vomiting,pulmonary infection,Postoperative cognitive dysfunction（POCD）,and anesthesia satisfaction.Results:（1）At time T0,there were no statistically significant differences in heart rate and mean arterial pressure among all groups.（2）There was no statistically significant difference in SPO2among the three groups at each time point（P>0.05）.There was no significant difference in the values of HR and MAP at T2,T3,T4 and T5 in the three groups,however,at T1,the HR of group C and L was 59.12±4.90 times/min and 68.25±6.55 times/min,respectively,lower than that of group B 84.26±5.23 times/min..At T5,the HR58.25±7.38 times/min in group L was lower than that in group C（68.24±4.51 times/min）and group I（62.81±5.56times/min）,and the difference was statistically significant（P<0.05）;At time T1 and time T6,The MAP of group C（73.63±3.22mm Hg,72.69±2.09mm Hg）and group L（81.15±2.17mm Hg,74.75±4.68mm Hg）were lower than those of group I（92.16±3.60mm Hg,89.52±0.68）Mm Hg）,and the difference was statistically significant（P<0.05）.（3）There was no significant difference in intraoperative blood loss among all groups,but group L was better than group I in nausea and vomiting,pulmonary infection and anesthesia satisfaction.The incidence of postoperative pharyngeal pain in group L was lower than that in group I.（4）There was no statistical difference in POCD among the three groups.（5）The postoperative activity time of group L（1.65±0.22d）and discharge time of group L（10.34±1.42d）were significantly shorter than those of group C（2.97±0.25d,14.98±1.72d）and group I（1.93±0.39d,12.02±1.62d）（P<0.05）;The extubation time of group L was 9.34±1.34min shorter than that of group I,12.90±2.01min（P<0.05）.Conclusion:1.Compared to the waist hard joint anesthesia and lumbar plexus nerve block guided by ultrasound in combination with endotracheal intubation anesthesia,lumbar plexus nerve block guided by ultrasound in combination with laryngeal mask anesthesia can significantly reduce the incidence of nausea and vomiting,elderly patients with lung infection,and can effectively shorten the patients postoperative extubation time,bed activity time and discharge time,The results indicated that ultrasound-guided lumbar plexus block combined with laryngeal mask general anesthesia can quickly recover after total hip arthroplasty in elderly patients,which is in line with the ERAS concept.2.Ultrasound-guided lumbar plexus nerve block combined with laryngeal mask general anesthesia in elderly patients with total hip arthroplasty can better reduce the circulation fluctuation of patients,anesthesia effect is significant,good safety,and has practical clinical application value. |
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