不同下肢神经阻滞复合全麻用于老年膝关节置换术的临床效果  

Efficacy of different lower extremity nerve block combined with general anesthesia in total knee arthroplasty in elderly patients

作　　者：罗振国[1] 肖莉[1] 吴刚[2] 李靖[1] 董补怀[1] 薛荣亮[2] 

机构地区：[1]西安交通大学医学院附属红会医院麻醉科,西安710054 [2]西安交通大学第二附属医院麻醉科

出　　处：《山西医科大学学报》2014年第7期657-660,共4页Journal of Shanxi Medical University

摘　　要：目的比较不同下肢神经阻滞复合全麻用于老年膝关节置换术的临床效果。方法择期行膝关节置换老年患者48例,ASAⅠ-Ⅱ级,年龄60-78岁,体重51-83 kg。患者随机分为三组(n=16):全麻组(Ⅰ组)、股神经阻滞组(Ⅱ组)、股神经阻滞+坐骨神经阻滞组(Ⅲ组),均在气管插管下行静吸复合全麻。Ⅱ、Ⅲ组麻醉诱导前在神经刺激仪引导下行神经阻滞。记录术前(T1)、手术开始(T2)、手术开始后60 min(T3)、术毕(T4)各时点HR和MAP,苏醒时间及苏醒期躁动发生率,记录术后6 h、12 h和24 h患者静息和活动时的VAS评分及术后12 h和24 h内舒芬太尼消耗量。结果 T2、T3、T4时Ⅰ组HR和MAP较Ⅱ、Ⅲ组升高明显(P<0.05)。与Ⅰ组比较,Ⅱ、Ⅲ组苏醒时间短,躁动发生少(P<0.05)。术后6 h及12 hⅠ组VAS(静息痛和活动痛)评分高于Ⅱ、Ⅲ组(P<0.05);Ⅲ组VAS评分(活动痛)低于Ⅱ组(P<0.05)。术后12 h和24 h内舒芬太尼消耗量Ⅰ组明显多于Ⅱ、Ⅲ组(P<0.05)。结论老年膝关节置换术采用全麻复合下肢神经阻滞与全麻相比,血流动力学更稳定、术后早期镇痛满意度更高;但股神经阻滞联合坐骨神经阻滞复合全麻与股神经阻滞复合全麻比仅减轻术后活动时的疼痛。Objective To compare the efficacy of different lower extremity nerve block combined with general anesthesia in total knee arthroplasty in elderly patients.Methods Forty-eight ASA Ⅰ-Ⅱ patients aged 60-78 years weighing 51-83 kg undergoning elective total knee arthroplasty under general anesthesia were selected,and randomly divided into three groups （n =16）：general anesthesia group （group Ⅰ）,femoral nerve block group （group Ⅱ）,femoral nerve block combined with sciatic nerve block group （group Ⅲ）.Operations were performed under combined intravenous-inhalational anesthesia with endotracheal tube.The patients in group Ⅱ and group Ⅲ received nerve block guided by nerve stimulator before induction of anesthesia.All the patients were given postoperative patient-controlled intravenous analgesia with sufentanil.Heart rate（HR） and mean arterial pressure（MAP） were recorded before anesthesia （T1）,at the beginning of surgery （T2）,60 min after the beginning of surgery （T3） and the end of operation （T4）.The time of recovery and incidence of emergence agitation,visual analogue scale（VAS） （rest pain/movement pain）at postoperative 6 h,12 h and 24 h were evaluated,and sufentanil consumption within 12 h and 24 h were also recorded.Results HR and MAP at T2,T3,T4 were significantly lower in groups Ⅱ and Ⅲ than those in group Ⅰ （P ＜ 0.05）.Compared with group Ⅰ,the time of recovery and incidence of emergence agitation decreased in group Ⅱ,Ⅲ （P ＜ 0.05）.VAS （rest pain and movement pain） was significantly higher in group Ⅰ than in group Ⅱ and group Ⅲ （P ＜ 0.05）.VAS（movement pain） was significantly lower in group Ⅲ than in group Ⅱ （P ＜ 0.05）.Compared with group Ⅰ,the consumption of sufentanil was significantly decreased within 12 h and 24 h after operation in group Ⅱ and group Ⅲ （P ＜ 0.05）.Conclusion Combined lower extremity nerve block is superior to the general anesthesia in hemodynamics and postoperative analge

关 键 词：神经传导阻滞 全身麻醉 老年人 全膝关节置换 

分 类 号：R614[医药卫生—麻醉学]