喉罩通气联合肌间沟臂丛阻滞麻醉在老年患者上肢手术中的应用  

The application of anesthesia by laryngeal masks combined with brachial plexus block in muscle between the groove in the upper limb surgery of the elderly patients

作　　者：杨帅[1] 华丽[1] 罗燕[1] 

机构地区：[1]成都大学附属医院麻醉科,四川成都610081

出　　处：《现代医药卫生》2015年第4期508-510,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨喉罩通气联合肌间沟臂丛阻滞麻醉在老年患者上肢手术中的临床应用。方法将2012年5月至2014年5月收治的150例择期行上肢手术的老年患者随机分为L组(喉罩通气全身麻醉联合臂丛阻滞麻醉)和B组(单纯臂丛阻滞麻醉)各75例。两组患者局部麻醉后在神经刺激仪定位下注入罗哌卡因,L组在麻醉诱导后置入喉罩,以丙泊酚和瑞芬太尼维持麻醉。B组给予面罩吸氧,必要时给予咪唑安定和芬太尼辅助麻醉。观察两组患者围术期生命体征变化、L组随访术中知晓情况,B组采用视觉模拟评分评估术中疼痛程度,随访两组患者麻醉相关并发症发生情况。结果 L组患者围术期心率、血压、脉搏血氧饱和度变化明显小于B组,术中知晓发生率、术中疼痛程度明显低于B组,差异均有统计学意义(P<0.01);两组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论喉罩通气联合肌间沟臂丛阻滞麻醉既能保证充分镇痛、镇静的麻醉效果,又能维持患者围术期生命体征平稳,避免术中知晓,对于老年患者,尤其是高龄、伴心血管疾病的患者行上肢手术更具有优势。Objective To investigate the clinic application of anesthesia by laryngeal masks combined with brachial plexus block in muscle between the groove in the upper limb surgery of the elderly patients. Methods A total of 150 elderly patients underwent elective upper limb surgery from May 2012 to May 2014 were randomly divided into group L（the laryngeal masks combined with brachial plexus block in muscle） and group B（the brachial plexus block in muscle between the groove）,each of 75 cases. The patients in the two groups after local anesthesia were implanted ropivacaine under the nerve stimulator. Group L was inserted laryngeal masks after induction of anesthesia,maintaining Protocol and remifentanil anesthesia while Group B given the oxygen mask,assisting with midazolam and fentanyl anesthesia when it was necessary. It was observed the vital signs change of perioperative period in the two groups,intraoperative awareness by follow-up in group L,the intraoperative pain degree evaluated by VAS score adopted by group B,the complications related to the anesthesia in the two groups by follow-up. Results The heart rate in the perioperative period,blood pressure,the pulse blood oxygen saturation change were lower than those of group B,whose difference was statistical significance（P〈0.01）;The incidence rate of the postoperative complications were distinctly lower that of the two groups had no statistical significance（P〉0.05）. Conclusion The clinic application of anesthesia by laryngeal masks combined with brachial plexus block in muscle between the groove in the upper limb surgery had more advantages in analgesic and sedation and keeping a steady vital signs in the perioperative period,avoiding intraoperative awareness,especially for the aged conducting upper limb surgery with cardiovascular diseases.

关 键 词：喉面罩 麻醉 全身 老年人 肌间沟 臂神经丛阻滞 上肢手术 

分 类 号：R687.3[医药卫生—骨科学]