超声引导下神经阻滞复合喉罩全身麻醉对老年髋关节置换手术麻醉和术后镇痛效应的影响  

Effects of ultrasound-guided nerve block combined with laryngeal mask airway on anesthesia and postoperative analgesia in hip anthroplasty for the elderly

作　　者：朱俊峰[1] 冯兆明[1] 

机构地区：[1]上海交通大学附属第六人民医院金山分院麻醉科,201500

出　　处：《中华生物医学工程杂志》2015年第6期528-531,共4页Chinese Journal of Biomedical Engineering

摘　　要：目的探讨超声引导下腰丛、骶丛神经阻滞复合喉罩全身麻醉对老年髋关节置换手术麻醉和术后镇痛效应的影响。方法40例择期行髋关节置换手术的老年患者，年龄65-85岁，体重45-70kg，ASA Ⅱ-Ⅲ级，随机分为常规气管插管静吸复合全身麻醉组（C组，对照组）和超声引导下神经阻滞复合喉罩全身麻醉组（E组，实验组），每组20例。两组术后均采用患者自控静脉镇痛（PCIA）。记录两组术中芬太尼使用剂量及术后48h内PCIA用药总量和有效按压次数。分别于气管插管即刻或置人喉罩即刻（T0）、手术切皮即刻（T1）、假体置入时（T2）、缝合切口时（T3）、人麻醉苏醒室（PACU）后15min（T4）、30min（T5）、45min（T6）各时间点，记录患者心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）。记录术后2h、6h、12h、24h、48h的视觉模拟评分（VAS）及不良反应发生情况。结果C组在T1-T6各时间点HR、MAP均明显高于E组（P〈0．05，P〈0．01）；术中芬太尼使用剂量及术后48h内PCIA用药总量和有效按压次数C组也显著高于E组[术中芬太尼使用剂量：（428±36）μg比（145±12）μg，术后48h内PCIA用药总量：（89±11）ml比（60±13）ml，有效按压次数：（12．4±3.3）次比（4．2±1．1）次，均P〈0．01]；各时间点VAS评分C组亦明显高于E组（P〈0．05）；C组术后恶心、呕吐、咽喉疼痛发生率明显高于E组（P〈0．05）。结论超声引导下腰丛、骶丛神经阻滞复合喉罩全身麻醉用于老年髋关节置换手术，血流动力学相对平稳，术后镇痛需求量降低，不良反应少。Objective To evaluate the effects of uhrasound- guided lumbar plexus/sacral plexus blockage combined with laryngeal mask airway （LMA） on anesthesia and postoperative analgesia for hip anthroplasty in the elderly. Methods Forty elderly patients undergoing elective hip anthroplasty, aged 65 to 85 years old, weighing 45 to 70 kg, with American Society of Anesthesiologists （ASA） grades ]I to m , were randomly divided into a general anesthesia group using conventional endotracheal intubation and intravenous drip （group C, control group） and another using ultrasound-guided nerve block and LMA （group E, the study group） , with 20 patients in each group. Postoperative patient-controlled intravenous analgesia （PCIA） was used in all patients. For the two groups, we recorded the intraoperative fentanyl dosage, and total dose of PCIA agents and total times of effective PCIA-pump pressing within 48 h after surgery. We also recorded the heart rate （HR）, mean arterial pressure （MAP）, and pulse oximetry （SpO2） of the patients at several time points： immediately after tracheal intubation or at placement of LMA （T0）, at the time of skin incision （T1）, prosthesis implantation （T2）, suturing of the incision （T3）, and at 15 min （T4）, 30 min （T5）, and 45 min （T6） in the anesthesia recovery room （PACU）. Visual analog scales （VAS） and adverse events at 2 h, 6 h, 12 h, 24 h, 48 h afterh surgery were also recorded. Results At any of time points T1 to T6, group C showed significantly higher HR （P〈0.05） and MAP （P〈0.01） than group E. Compared with group E, group C also showed significantly more intraoperative dosage and total dose of PCIA agents and total times of effective PCIA-pump pressing within 48h after surgery [intraoperative use of fentanyl dose： （428＋36） μg vs （145＋12） μg; total dose of PCIA agents within 48 h after surgery： （89±11） ml vs （60±13） ml; effective pump-pressing times： （12.4±3.3） vs （4.2±1.1 ）, all P

关 键 词：超声检查 神经传导阻滞 喉面罩 关节成形术 置换 髋 老年人 

分 类 号：R614.2[医药卫生—麻醉学]