| Objective:To investigate the effect of lumbar plexus block combined with general anesthesia under different BIS values in elderly hip replacement.Methods:Eighty elderly patients,age 65-85,ASA ?-? undergoing selective hip arthroplasty in Yanbian University Affiliated Hospital from January 2017 to December 2018 were selected.They were randomly divided into A,B,C,D four groups,each group had 20 cases.They were general anesthesia with BIS value of 50-59(group A,n=20),general anesthesia with BIS value of 40-49(group B,n=20),combined lumbar plexus block with general anesthesia,combined lumbar plexus block with BIS value of 50-59(group C,n=20)and combined lumbar plexus block with general anesthesia with BIS value of 40-49(group D,n=20),maintaining the change range of BIS in the whole course at about(+2%).Four groups were given routine ECG monitoring,ECG,SPO2 and NIBP after admission.Patients in group A and B were given general anesthesia directly.Patients in group C and D were given 0.4%ropivacaine for 30 ml after lumbar plexus block and then were given general anesthesia.Induction of general anesthesia:dexamethasone 10 mg,dizosin 5 mg,midazolam 0.04-0.06 mg/kg,cisatracurium 0.2-0.25 mg/kg,etomidate 0.2-0.3 mg/kg,5 minutes before skin opening give sufentanil0.2-0.3 ug/kg.Analyzed the HR and MAP of patients at admission(T0),operation start(T1),prosthesis placement(T2),operation end(T3),enter awakening room(T4)and 30 minutes in awakening room(T5),the dosage of general anesthetics,intraoperative use of vasoactive drugs,postoperative respiratory recovery time,extubation time,30-minute Awakening Room Aldrete score,recovery time of Awakening Room,intraoperative awareness and postoperative cognitive impairment.Result:(1)Hemodynamics:Compared with T0,MAP and HR in group A and B increased at T1 and T2,and decreased at T3-T5 compared with T2(P<0.05).Compared with group T0,MAP and HR in group C decreased at T1(P<0.05).There was no significant difference at T2-T5 with TO(P<0.05).And in group D,MAP and HR at T1-T5 were significant decreased(P<0.05).Compared with group A,the increase of MAP and HR at T1-T2 time in group B was lower,and the decrease of MAP and HR at T1-T3 in group C was significantly lower.Compared with group C,the decrease of MAP and HR at T1-T5 in group D was greater than that in group C(P<0.05),and the increase of MAP and HR at T5 time in group A was significantly higher than that at T3 time(P<0.05),In group C,compared with T3 MAP and HR,there was no statistical significance.(2)Dosage of general anesthesia:Compared with group A,the dosage of propofol in group B was higher than that in group A(P<0.05);the dosage of propofol,sufentanil and the number of use of vasoactive drugs in group C was significantly lower than that in group A(P<0.01).Compared with group C,propofol dosage in group D was higher than that in group C(P<0.05).(3)Postoperative recovery:Compared with group A,group B had a longer respiratory recovery time and a longer postoperative recovery time in the recovery room(P<0.05).The breathing recovery time and extubation time in group C were significantly shortened,and the recovery time in the recovery room was shortened(P<0.01).Compared with group C,group D had longer respiratory recovery time and longer recovery time in the recovery room(P<0.05).The 30-minute Aldrete score of group A was significantly higher than that of group B and lower than that of group C.The 30-minute Aldrete score of group D was lower than that of group C(P<0.05).(4)None of the patients had intraoperative awareness and postoperative cognitive impairment.Conclusion:(1)The hemodynamics during general anesthesia is more stable when the BIS value is maintained between 40 and 49,but the dosage of general anesthesia is large and the recovery effect is poor.(2)When BIS is maintained in the range of 50-59,general anesthesia combined with lumbar plexus nerve block can achieve good anesthesia and recovery effect in elderly hip replacement,and ensure the safety of elderly patients in perioperative period. |
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