轻比重布比卡因单侧腰麻联合隐神经阻滞对老年膝关节置换术后快速康复的影响  

Effect of Light Gravity Bupivacaine for Unilateral Spinal Anesthesia Combined with Ultrasound-Guided Saphenous Nerve Block on Fast Track Recovery in Elderly Patients Undergoing Total Knee Arthroplasty

作　　者：吴捷 陈佳 王亚琴 王敏 陈杰 葛亚丽[2] WU Jie;CHEN Jia;WANG Yaqin;WANG Min;CHEN Jie;GE Yali(Taizhou Integrated Traditional Chinese and Western Medicine Hospital,Taizhou,Jiangsu 225300,China;Subei People's Hospital,Yangzhou,Jiangsu 225001,China)

机构地区：[1]泰州市中西医结合医院,江苏泰州225300 [2]苏北人民医院,江苏扬州225001

出　　处：《大医生》2019年第15期10-12,48,共4页Doctor

摘　　要：目的观察超声引导下隐神经阻滞联合轻比重布比卡因单侧腰麻在促进老年膝关节置换术后快速康复中的应用。方法选取2016年7月至2018年7月泰州市中西医结合医院收治的50例患者,采用随机数字表法将患者分为两组:单侧腰麻联合隐神经阻滞组(A组),传统双侧腰麻组(B组),每组25例。A组术前行超声引导下行隐神经阻滞,后于L3-4行轻比重布比卡因单侧腰麻(0.2%布比卡因3 mL,6 mg);B组于L3-4行0.75%布比卡因双侧腰麻(0.75%布比卡因1.5 mL,11 mg)。记录腰麻实施前即刻,实施后5、15、30 min血压、心率的变化,记录术后首次下地时间,首次行走距离,首次术后补救镇痛时间、术后48 h补救镇痛药物总剂量及术后住院天数;记录术后恶心呕吐、意外跌倒的发生情况。结果B组腰麻实施后30 min内,心率明显增快,平均压(MAP)明显降低(P<0.05),A组腰麻实施后循环基本稳定;与B组相比,A组较早下地行走,且行走距离较长,术后住院时间较短,MAP术后较迟需要补救镇痛,术后48 h补救镇痛药物总剂量较小,术后意外跌倒、恶心呕吐发生两组差异无统计学意义(P>0.05)。结论单侧腰麻联合超声引导下隐神经阻滞可较好维持膝关节置换术患者循环的稳定,缓解术后早期疼痛,利于患者术后早期下床锻炼,促进患者的康复。Objective To investigate the application of light gravity bupivacaine for unilateral spinal anesthesia combined with ultrasound-guided saphenous nerve block(SNB)on fast track recovery after total knee arthroplasty in the elderly patients.Methods A total of 50 patients admitted to Taizhou Integrated Traditional Chinese and Western Medicine Hospital from July 2016 to July 2018 were divided into two groups:unilateral lumbar anesthesia combined with saphenous nerve block group(group A)and traditional bilateral lumbar anesthesia group(group B),25 cases per group.In group A,saphenous nerve block was performed under ultrasound guidance before operation,and then unilateral lumbar anesthesia with light specific gravity bupivacaine(0.2%bupivacaine 3 mL,6 mg)was performed at L3-4,while in group B,bilateral lumbar anesthesia with 0.75%bupivacaine(0.75%bupivacaine 1.5 mL,11 mg)was performed at L3-4.The changes of blood pressure and heart rate were recorded immediately before and 5,15 and 30 min after the implementation of lumbar anesthesia.The first time to go to the ground after operation,the first walking distance,the first time to relieve pain after operation,the total dose of relief analgesics 48 h after operation and the days of hospitalization after operation were recorded.The occurrence of nausea,vomiting and accidental falls after operation were recorded.Results MAP,HR in Group A were significantly more stable than Group B after anesthesia,MAP was obviously decreased,and HR was significantly increased in Group B in 20 minutes after anesthesia(P<0.05).Compared with Group B,the first time to walk was shorter,and the walking distance was longer in Group A.The first time to receive additional analgesics was later in Group A,and the total dose of additional analgesics was lower in Group A when comparing to Group B.The days of postoperative hospital stay was shorter in group A than Group B.The rates of PONV and accidental falls were comparable between the two groups(P>0.05).Conclusion The application of unilateral spinal an

关 键 词：腰麻 单侧 关节成形术 置换 膝 隐神经阻滞 老年 

分 类 号：R47[医药卫生—护理学]