联合引导实施股神经-股外侧皮神经阻滞麻醉与全身麻醉在老年膝关节手术中的探讨  

Effect of ultrasound- and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia on knee joint surgery in elderly patients

作　　者：高涛[1] 邓迎丰[2] 刘慧松 涂灿[4] 魏鹏[2] 尹峰[1] 

机构地区：[1]同济大学医学院附属东方医院骨科,上海200092 [2]宁波大学医学院附属医院麻醉科 [3]宁波大学医学院附属医院骨科 [4]宁波大学医学院附属医院影像科

出　　处：《中华老年医学杂志》2015年第10期1103-1106,共4页Chinese Journal of Geriatrics

基　　金：宁波市医学科技计划项目（2014A07）

摘　　要：目的探讨B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞麻醉与全身麻醉在老年患者下肢膝关节手术中的应用。方法将我院2014年6月至2015年6月收治的110例有椎管内麻醉高风险或禁忌证的老年下肢膝关节手术患者按随机数字法分成观察组（55例）和对照组（55例）两组。观察组采用B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞；对照组采用全身麻醉。记录并对比两组不同方案的麻醉操作及麻醉起效的时间、麻醉后心率与平均动脉压（MAP）的变化、补液量和升降压药的使用量、不良反应、患者麻醉费用、麻醉效果。结果观察组麻醉准备和操作时间（8．3±1．7）min与对照组（7．7±1．2）min相当（t=1．661，P=0．139）；麻醉起效时间（10．3±1．4）min比对照组（3．2±0．6）min长（t=50．180，P〈0．01）；观察组与对照组MAP在麻醉后5min（89．24±8．30）mmHg；（77．90±8．05）mmHg以及手术结束时（96．60±8．03）mmHg；（106．22±8．88）mmHg变化明显（P〈0．05）；观察组与对照组在输液量（1150．9±231．6）ml、（1400．0±256．5）ml、升压药用量（3．91±1．21）mg、（10．83±2．19）mg、降压药用量（1．80土0．37）mg、（8．27士1．25）mg、麻醉费用（1239．1±202．9）元、（2307．2±205．6）元、麻醉中和麻醉后不良事件发生率（3．6％、18．20）差异均有统计学意义（t=6．024、2．760、4．420，27．430，χ2=8．510，均P〈0．01或0．05）；麻醉效果两组差异无统计学意义（t=1．657，P=0．198）。结论B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞麻醉在老年患者下肢膝关节手术中应用更简单安全实用，并发症更少，费用更低，患者满意度更高。Objective To investigate the effect of ultrasound- and nerve stimulatorguided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia on knee joint surgery in elderly patients. Methods The 110 elderly patients with spinal anesthetic contraindication and undergoing lower extremity surgery from June 2014 to June 2015 were randomly divided into observation group （n = 55） and control group （n = 55 ）. The observation group received both ultrasound-and nerve stimulatorguided femoral nerve and lateral femoral cutaneous nerve block, and the control group was given general anesthesia. Anesthesia procedure, sensory block onset time, changes in heart rate and mean artery pressure （MAP） after anesthesia, the total quantity of fluids infusion, dosage of vasopressor and hypotensor, adverse anesthetic reactions, anesthetic fees, anesthetic effect were recorded. Results Anesthetic preparation and practicing time had no difference between the two groups [（8.3±1.7） min vs. （7.7±1.2） min, （t=1. 661, P=0.139）3. The block onset time was longer in observation group than in control group [（10.3±1.4） min vs（3.2±0.6） min, t=50. 180, P〈0. 011. The changes in MAP had significant difference between the two groups （5 min after anesthesia= （89.24 ± 8.30） mmHg and （77.90 ±8.05） mmHg; after operation= （96.60±8.03） mmHg and （106.22±8. 88） mmHg P〈0. 051. There were significant differences in the fluid infusion quantity, dosage of vasopressor and hypotensor, adverse reactions during or after anesthesia, and anesthetic fees between the two groups （（ 1150.9 ±231.6） ml vs （1400.04-256.5） ml, （3. 91±1.21） mg va （10.83±2.19）mg, （1.80±0.37） mg w （8.27±1.25） mg, 3.6% w18.2% （1239.1±202.9） Yuan w （2307.2±205.6） Yuan, all P〈0.051. No significant difference was found in anesthesia effect between the two groups （P = 0. 198）. Conclusions The ultrasoundand nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerv

关 键 词：超声检查 神经传导阻滞 周围神经 麻醉 全身 膝关节 

分 类 号：R614[医药卫生—麻醉学]