[1]邓厚盛 张治明 姜黎珊 陆雅萍 刘明娟.超声引导下改良腰骶丛阻滞联合MAC与脊髓麻醉对老年髋关节手术患者血浆炎症因子影响的比较[J].中华老年骨科与康复电子杂志,2026,(01):31-37.[doi:10.3877/cma.j.issn.2096-0263.2026.01.005]
　Deng Housheng,Zhang Zhiming,Jiang Lishan,et al.Comparison of the effects of ultrasound-guided modified lumbosacral plexus block combined with MAC and spinal anesthesia on plasma inflammatory factors in elderly patients undergoing hip surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2026,(01):31-37.[doi:10.3877/cma.j.issn.2096-0263.2026.01.005]
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超声引导下改良腰骶丛阻滞联合MAC与脊髓麻醉对老年髋关节手术患者血浆炎症因子影响的比较()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2026年01期
页码:
31-37
栏目:
麻醉医学
出版日期:
2026-02-05

文章信息/Info

Title:
Comparison of the effects of ultrasound-guided modified lumbosacral plexus block combined with MAC and spinal anesthesia on plasma inflammatory factors in elderly patients undergoing hip surgery
作者:
邓厚盛1 张治明1 姜黎珊2 陆雅萍2 刘明娟2
423003 郴州市第一人民医院麻醉科1；314001 嘉兴市第一医院麻醉与疼痛医学中心2
Author(s):
Deng Housheng1;  Zhang Zhiming1;  Jiang Lishan2;  Lu Yaping2;  Liu Mingjuan2.
1Department of Anesthesiology, Chenzhou First People’s Hospital, Chenzhou City, Hunan Province 423003, China; 2Department of Anesthesiology and Pain Research Center, Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
关键词:
改良腰骶神经丛阻滞;  脊髓麻醉;  老年患者;  髋部手术
Keywords:
Modified lumbosacral plexus block anesthesia;  Spinal anesthesia;  Elderly patients;  Hip surgery
DOI:
10.3877/cma.j.issn.2096-0263.2026.01.005
文献标志码:
A
摘要:
目的 比较超声引导下改良腰骶神经丛阻滞（MLPB）联合监护下麻醉管理（MAC）与脊髓麻醉（SA）对老年髋关节手术患者围手术期预后及炎症应激反应的影响。方法 招募2019年1月至2020年1月嘉兴市第一医院骨科行单侧髋关节手术患者62例，年龄65～90岁，ASA分级Ⅱ或Ⅲ级。所有招募者以随机数字表法被分为2组，MLPB组和SA组。MLPB组在手术前进行超声引导下改良型腰骶丛神经阻滞，分别于患者手术侧腰丛和骶丛注射 0.375% 罗哌卡因30 ml，并术中联合MAC；SA 组蛛网膜下腔注射0.375%盐酸罗哌卡因1.5 ml和无菌水1 ml共2.5 mL进行脊髓麻醉。主要观察指标是术后6 h血浆IL-1β，IL-6和TNF-α浓度。次要观察指标有围术期血流动力学的变化、术后6 h、12 h、24 h、36 h、48 h静息时和运动时疼痛评分以及围术期不良反应的发生情况。结果 与MLPB组相比，SA组术后6 h血浆IL-1β、IL-6、TNF-α水平显著升高（P＜0.05）。SA组在麻醉结束时及麻醉结束后15分钟收缩压、舒张压、平均动脉压均显著降低（P＜0.05）。在SA组中，53.33%的患者至少发生过一次严重低血压，而MLPB组中仅有6.45%的患者发生过显著性低血压（P＜0.05）。此外，与MLPB组相比，SA组患者在术后6 h和12 h静息时和运动时疼痛评分较高，差异具有统计学意义。同时SA组恶心、呕吐发生率显著增加（P＜0.05），其他并发症发生率两组比较差异无统计学意义。结论 超声引导下MLPB联合MAC能降低老年患者术后的炎症刺激，且患者术中血流动力学较稳定，术后疼痛刺激减少，不良反应发生减少，在老年髋关节手术中有更好的麻醉效果。
Abstract:
Objective To compare the effects of ultrasound-guided modified lumbosacral plexus block (MLPB) combined with monitor anesthesia care (MAC)and spinal anesthesia (SA) on perioperative prognosis and inflammatory stress response in elderly patients undergoing hip surgery. Methods From January 2019 to January 2020, 62 patients aged 65-90 years old, ASA grade Ⅱ or Ⅲ, underwent unilateral hip operation in the Department of Orthopedics of Jiaxing First Hospital. All the recruiters were divided into 2 groups, MLPB group and SA group, according to random number table method. The MLPB group underwent ultrasus-guided modified lumbosacral plexus block before surgery, and 0.375% ropivacaine 30 ml was injected into the lumbosacral plexus and sacral plexus respectively on the surgical side, and intraoperative combined MAC. In SA group, 1.5 ml of 0.375% ropivacaine hydrochloride and 1 ml of sterile water was injected into subarachnoid space for spinal anesthesia. The main outcome measures were theplasma concentrations ofIL-1β, IL-6, and TNF-α at 6 h after surgery. Secondary outcome measures included perioperative hemodynamic changes, resting and moving pain scores at 6h, 12 h, 24 h, 36 h, 48h, and perioperative adverse reactions. Results Compared with MLPB group, plasma levels of IL-1β, IL-6 and TNF-α in SA group at 6 h after operation were significantly increased (P<0.05). In SA group, systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly decreased at the end of anesthesia and 15 minutes after anesthesia (P<0.05). In the SA group, 53.33% of patients experienced at least one episode of severe hypotension, while only 6.45% of patients in the MLPB group experienced significant hypotension (P<0.05). In addition, compared with the MLPB group, patients in the SA group had higher pain scores at resting and moving at 6 and 12 hours after surgery, and the difference was statistically significant. At the same time, the incidence of nausea and vomiting in SA group was significantly increased (P<0.05), and the incidence of other complications was not statistically significant between the two groups. Conclusion Ultrasound-guided MLPB combined with MAC can reduce postoperative inflammatory stimulation in elderly patients, and the hemodynamics of patients are stable, the postoperative pain stimulation is reduced, the occurrence of adverse reactions is reduced, and there is a better anesthetic effect in elderly hip surgery.

备注/Memo

备注/Memo:
基金项目：浙江省医药卫生科技计划（2020KY949）；浙江省麻醉学临床重点专科资助（2023-ZJZK-001）；郴州市第一人民医院院级科研项目（N20206）以及郴州市重点研发项目（ZDYF2020012）；湘南学院校级科研项目（2025XJ91）临床试验注册：中国临床试验注册中心，ChiCTR2000041250
更新日期/Last Update: 2026-05-18