全麻复合神经阻滞在全膝关节置换手术的应用  

Application of general anesthesia combined with nerve block in total knee replacement

作　　者：张晓琳[1] 柴小青[1] 周玲[1] 谢言虎[1] 张晓琪[1] 王迪[1] 

机构地区：[1]安徽医科大学附属安徽省立医院麻醉科,安徽省230001

出　　处：《江苏医药》2015年第17期2047-2049,共3页Jiangsu Medical Journal

摘　　要：目的探讨全麻复合神经阻滞用于全膝关节置换手术(TKR)的麻醉效果。方法 TKR患者60例,随机均分为两组:G组单用丙泊酚和雷米芬太尼维持全身麻醉;N组全麻复合坐骨神经和股神经阻滞,全身麻醉深度依据NarcotrendTM指数(NTI)调节,神经阻滞在超声定位下实施。连续监测ECG、MAP、HR、SpO2和PETCO2,记录麻醉药用量。术后实施静脉患者自控镇痛,随访VAS疼痛评分和第一次需要加用镇痛药的时间。结果与G组比较,N组术中丙泊酚及雷米芬太尼的用量减少(P<0.01)。与麻醉诱导前比较,N组术中MAP和HR无统计学变化(P>0.05),但G组切皮和术毕时的MAP和HR均较麻醉前升高(P<0.05)。N组术后第一次应用镇痛药时间较晚[(11.7±0.8)h vs.(3.5±1.2)h](P<0.01)。结论 TKR患者采用在NTI监测和超声引导下实施全麻复合神经阻滞麻醉效果满意,循环稳定,全麻用药减少。Objective To observe the outcomes of general anesthesia combined with nerve block in total knee replacement（TKR）. Methods Sixty patients scheduled for TKR were equally assigned into two groups of G（anesthetized with conventional general anesthesia） and N （anesthetized with general anesthesia combined with nerve block）. The apropriate depth of general anesthesia with propofol and ramifentanil in group N was maintained according to NarcotrendTM index （NTI） monitoring and the sciatic and femoral nerve block was performed guided by ultrasound. ECG, MAP, HR, SpO2 and PErCO2 were monitored continuosly. The amount of anesthetics used was recorded. The intravenous patient-controlled analgesia was performed after operation. The VAS pain scores and the time for the first use of additional analgesics were followed up after operation. Results The amounts of propofol and remifentanil used in operation were significantly less in group N than those in group G （P^0. 01）. Compared to before induction, the MAP and HR in group N were not significantly changed during surgery （P〈0. 05）, which in group G were higher during skin incision and at the end of operation than those bef0re（P〈0. 05）. The time for the first use of analgesics after operation was longer in group N than that in group G[（11. 7±0. 8） h vs. （3.5±1.2） hi（P〈0. 01）. Conclusion Under NTI monitoring and guided by ultrasound, general anesthesia with propofol and ramifentanil combined with sciatic and femoral nerve blocks can provide satisfactory anesthesia with reduced need for anesthetic drugs and stable circulation in the patients undergoing TKR.

关 键 词：麻醉深度监测 全膝关节置换术 坐骨神经阻滞 股神经阻滞 

分 类 号：R614[医药卫生—麻醉学]