下肢神经阻滞复合喉罩全麻用于老年患者全膝关节置换术的临床观察  

Clinical observation of the general anesthesia with LMA combined with lower extremity nerve block in elderly patients undergoing total knee arthroplasty

作　　者：公茂伟[1] 袁维秀[1] 赵颖[1] 张永强[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《北京医学》2012年第8期641-643,共3页Beijing Medical Journal

摘　　要：目的评价下肢神经阻滞复合喉罩全麻在老年患者全膝关节置换术中应用的麻醉效果。方法择期行单侧全膝关节置换术的老年患者60例,年龄65～87岁,体重53～102kg,ASAⅡ～Ⅲ级,随机分为气管插管全麻组(T组)和神经刺激器引导下肢神经阻滞复合喉罩全麻组(L组),每组30例。T组行常规气管插管全身麻醉,L组在神经刺激器引导下实施下肢神经(腰丛-坐骨神经)阻滞后置入喉罩全麻。记录麻醉前(T1)、气管插管或喉罩置入即刻(T2)、手术切皮(T3)、屈膝剥离骨膜(T4)、拔气管导管或取出喉罩即刻(T5)等时间点的心率(HR)、平均动脉压(MAP);记录手术时间、止血带时间、术中全身麻醉药用量、术毕苏醒时间、拔气管导管或取出喉罩时间以及术后恶心呕吐、咽喉疼痛的发生情况等。结果 T2、T3、T4、T5时间点T组的HR均显著快于L组(P均<0.01),MAP均显著高于L组(P均<0.01);T组术中异丙酚用量、芬太尼使用总量及术后24h内患者自控镇痛(PCA)药物用量均显著高于L组(P均<0.01);术毕苏醒时间及拔气管导管或取出喉罩时间T组显著长于L组,T组术后恶心呕吐(PONV)和咽喉疼痛的发生率显著高于L组(P均<0.01)。结论下肢神经阻滞复合喉罩全麻可以安全有效地应用于老年全膝关节置换术,其生理干扰轻微并能提供良好的术后镇痛效果,并发症少。Objective To evaluate the efficacy of general anesthesia with laryngeal mask airway （LMA）combined with lower extremity nerve block in elderly patients undergoing total knee arthroplasty. Methods Sixty ASA Ⅱ -Ⅲ pa- tients, aged 65-87 yr, weighing 53-102 kg, undergoing total knee arthroplasty under general anesthesia, were randomly di- vided into 2 groups. Each group has 30 cases. Group T received conventional tracheal intubation general anesthesia. Group L received lower extremity nerve block guided by nerve stimulator and then combined intravenous-inhalation anes- thesia with laryngeal mask airway. The changes of MAP and HR were recorded before anesthesia （T1）, at the time of tra- cheal intubation or LMA insertion（T2）, cutting skin（T3）, periosteal detaching（T4） and extubation or LMA removal（TS）. The operation time, the tourniquet time, the time of extuhation or LMA removal and awareness during anesthesia were recorded. The intra-operative dosage of general anesthesia and the complications such as postoperative nausea and vomiting and throat pain were also recorded. Results At the time of T2,T3 ,T4,1＂5, MAP and HR in group T were significantly higher than those in group L（P 〈 0.01）, the dosages of propofol, fentanyl and PCA drug dosages within 24 h were also significant- ly higher than group L （P 〈 0.01）. The time of extubation or LMA removal and awareness in group T were longer than those in group L, and so as to the incidence of PONV and throat pain. Conclusions General anesthesia （GA） with LMA com- bined with lower extremity nerve block could be applied to elder patients undergoing total knee arthroplasty safely and ef- fectively. This procedure could maintain hemodynamic stability and provide good postoperative analgesia effect and less complications.

关 键 词：下肢神经阻滞 喉罩 老年 全膝关节置换 

分 类 号：R614[医药卫生—麻醉学]