下肢静脉区域阻滞用于老年患者单膝关节置换术的临床研究  

Application of lower extremity intravenous regional anesthesia in total knee replacement for elderly patients

作　　者：刘勇[1] 王业华[1] 柯明池[1] 蒋健[1] 王龙[1] 周治国[2] 

机构地区：[1]徐州医学院附属医院骨科,江苏徐州221006 [2]徐州医学院附属医院麻醉科,江苏徐州221006

出　　处：《生物骨科材料与临床研究》2016年第2期47-50,54,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨下肢静脉区域阻滞在老年单膝关节置换术中的可行性和安全性。方法选择本院2011年3月～2013年6月择期行单侧膝关节置换术老年患者48例,随机分为全身麻醉（General anesthesia,GA）组（n=24）,静脉区域阻滞（Intravenous regional anesthesia,IVRA）组（n=24）。分别记录两组入室诱导前（T0）、气管插管或静脉区域阻滞成功后（T1）、切皮（T2）、截骨（T3）和松止血带10分钟（T4）的收缩压、舒张压和心率。患者感觉神经阻滞的起效时间,阻滞完善时间及维持时间,术后关节活动度,并记录与麻醉相关的不良反应。结果静脉区域阻滞感觉阻滞起效时间为（5.04±1.08）分钟,维持时间（95.46±5.24）分钟。SBP和DBP在T3时心率和血压GA组低于IVRA组（P〈0.05）,T4时GA组高于IVRA组（P〈0.05）。IVRA组有7例在截骨时有体动反应,复合静脉用药可完成手术。IVRA组患者术后1周和2周所达到的最大活动度和GA组没有统计学差异（P〉0.05）。IVRA组术后恶心、呕吐和术后高血压发生率低于GA组（P〈0.05）。二组均无麻醉相关并发症。结论静脉区域阻滞用于老年患者单膝关节置换术安全有效,尤其适用于术后接受抗凝治疗以及不适合全身麻醉的老年患者。Objective To study the feasibility and safety of Intravenous Block Regional Anesthesia in total knee replacement for elderly patients. Methods Forty-eight patients who underwent unilateral knee replacement in our hospital from March 2011 to June 2013 were randomly divided into general anesthesia（GA） group and intravenous regional anesthesia（IVRA）group（24 in each group）. The systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）were recorded before anesthesia（T0）, immediately after tracheal intubation（T1）, skin cut（T2）, decollement and osteostomy（T3）, 10 min after removal of tourniquet（T4） in two groups. The beginning, peak and maintenance time of sensory nerve block, and the range of motion of the knee joint on post-operative 1 week, and on 2 week were recorded. Anesthesia-related adverse reactions were detected in two groups. Results Onset of sensory block was 5.04±1.08 min. The maintenance of sensory block was（95.46±5.24） min,（p〈 0.05）. The SBP and DBP were lower in GA group than in peripheral IVRA group at the time of decollement and osteostomy and higher in GA group than in peripheral IVRA group at T4（p〈 0.05）. The HR was lower in peripheral IVRA group at T2 than at T0（p〈 0.05）. Motor reactions were observed in 7 patients of peripheral IVRA group at osteostomy. The maximal range of the knee joint movement of IVRA group were similar to GA group on post-operative week 1 and 2（p〉0.05）. The incidence of nausea, vomiting and postoperative hypertension was lower in peripheral IVRA group than in GA group after operation. No anesthesia-related adverse reaction occurred in two groups. Conclusion Intravenous regional anesthesia is safe and effective in unilateral knee replacement for elderly patients, especially for those receiving anticoagulant therapy and those not fit for general anesthesia.

关 键 词：静脉区域阻滞麻醉 全身麻醉 人工全膝关节置换术 活动度 

分 类 号：R614[医药卫生—麻醉学]