超声引导下连续髂筋膜间隙阻滞复合右美托咪定在老年患者髌骨骨折手术中的应用  

Application of ultrasound-guided continuous fascia iliaca compartment block combined with dexmedetomidine to elderly patients undergoing patellar fracture surgery

作　　者：涂涛[1] 郭帅峰 王丽[1] TU Tao;GUO Shuai-feng;WANG Li(Department of Anesthesiology,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院麻醉科,四川省成都市610500

出　　处：《广西医学》2019年第2期178-181,共4页Guangxi Medical Journal

摘　　要：目的探讨超声引导下连续髂筋膜间隙阻滞(FICB)复合右美托咪定在老年患者髌骨骨折手术中的应用效果及安全性。方法将60例择期行手术治疗的老年髌骨骨折患者随机分为对照组与研究组,每组各30例。对照组患者行全身麻醉,术毕静脉自控镇痛;研究组患者在右美托咪定镇静后行超声引导下FICB,术后神经自控镇痛。记录并比较两组患者在麻醉前(T_1)、切皮时(T_2)、手术开始后10 min(T_3)、20 min(T_4)、术毕时(T_5)的HR、平均动脉压(MAP)及指脉血氧饱和度(SpO_2)。比较两组患者术后3 h、6 h、12 h、24 h、48 h的疼痛视觉模拟量表(VAS)评分、术后48 h不良反应发生情况及患者总满意率。结果研究组T_2、T_3时的MAP及HR均低于对照组,但两组的SpO_2水平比较,差异无统计学意义(P> 0. 05)。研究组术后48 h恶心及高血压发生率均低于对照组(P <0. 05)。研究组患者总满意率高于对照组(P <0. 05)。结论超声引导下连续FICB复合右美托咪定可以安全、有效地应用于老年患者髌骨骨折手术,有利于保持患者血流动力学稳定,并提供良好的术后镇痛和减少术后不良反应发生。Objective To investigate the effect and safety of ultrasound-guided continuous fascia iliaca compartment block(FICB)combined with dexmedetomidine in elderly patients undergoing patellar fracture surgery.Methods Sixty elderly patients with patellar fracture undergoing elective surgical treatment were randomly divided into control group or study group,with 30 cases in each group.The control group received general anesthesia and intravenous self-controlled analgesia after operation,while the study group received ultrasound-guided FICB after sedation with dexmedetomidine and self-controlled neurological analgesia after operation.Before anesthesia(T1),at skin incision(T2),10 minutes after operation(T3),20 minutes after operation(T4),and at the end of operation(T5),HR,mean arterial pressure(MAP)and finger pulse oxygen saturation(SpO2)were recorded and compared between the two groups.The pain visual analogue scale(VAS)scores of 3,6,12,24 and 48 hours after operation,and incidence of adverse reactions and total satisfaction rate of patients 48 hours after operation were compared between the two groups.Results MAP and HR were lower in the study group than in the control group at T2 and T3(all P<0.05),but no significant difference existed in the level of SPO2 between the two groups(P >0.05).Incidences of nausea and hypertension 48 hours after operation were lower in the study group than in the control group(P<0.05).Total satisfaction rate of the study group was higher than that of the control group(P<0.05).Conclusion Ultrasound-guided continuous FICB combined with dexmedetomidine can be safely and effectively applied to patellar fracture surgery in elderly patients,which is conducive to maintaining hemodynamic stability,providing good postoperative analgesia,and reducing the occurrence of adverse reactions.

关 键 词：髌骨骨折 超声引导 髂筋膜间隙阻滞 右美托咪定 老年人 

分 类 号：R614[医药卫生—麻醉学]