超声引导股神经、腘窝入路坐骨神经阻滞复合全麻对胫骨远端骨折患者术中丙泊酚用量及术后苏醒时间的影响  

Influence of ultrasound-guided femoral nerve and popliteal approach sciatic nerve block combined with general anesthesia on intraoperative propofol dosage and postoperative awakening time of patients with distal tibial fracture

作　　者：常燕[1] Chang Yan(Department of Anesthesiology,Yijishan Hospital of Wannan Medical College,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院弋矶山医院麻醉科,安徽芜湖241000

出　　处：《右江民族医学院学报》2020年第4期481-484,共4页Journal of Youjiang Medical University for Nationalities

摘　　要：目的探究超声引导股神经、腘窝入路坐骨神经阻滞复合全麻对胫骨远端骨折患者术中丙泊酚用量及术后苏醒时间的影响。方法选取我院2018年6月—2019年8月胫骨远端骨折患者86例,按随机数字表法分为两组,各43例。对照组给予全身麻醉,观察组给予超声引导股神经、腘窝入路坐骨神经阻滞复合全麻。对比两组麻醉前(T 1)、插管时(T 2)、内固定时(T 3)、术毕(T 4)的心率(HR)和平均动脉压(MAP),术后苏醒时间、拔管时间、术中丙泊酚与瑞芬太尼用量,术后12 h、24 h视觉模拟评分法(VAS)评分,术前、术后24 h、术后3 d血清中疼痛介质水平[β-内啡肽(β-EP)、降钙素基因相关肽(CGRP)]。结果T 2、T 3、T 4两组HR、MAP均高于T 1,但观察组低于对照组(P<0.001);观察组术后苏醒时间、拔管时间短于对照组,术中丙泊酚与瑞芬太尼用量低于对照组(P<0.001);术后12 h、24 h观察组VAS评分低于对照组(P<0.001);术后24 h、术后3 d观察组血清β-EP、CGRP水平低于对照组(P<0.001)。结论超声引导股神经、腘窝入路坐骨神经阻滞复合全麻应用于治疗胫骨远端骨折患者,可稳定血流动力学,降低术中丙泊酚与瑞芬太尼用量,缩短术后苏醒时间,减轻术后疼痛。Objective To explore the influence of ultrasound-guided femoral nerve and popliteal approach sciatic nerve block combined with general anesthesia on intraoperative propofol dosage and postoperative awakening time of patients with distal tibial fracture.Methods Eighty-six patients with distal tibial fracture in our hospital from June 2018 to August 2019 were selected and divided into two groups according to random number table method,with 43 patients in each group.The patients in the control group were given general anesthesia,while the patients in the observation group were given ultrasound-guided femoral nerve and popliteal approach sciatic nerve block combined with general anesthesia.The heart rates(HR)and mean arterial pressure(MAP)of these two groups before anesthesia(T 1),during intubation(T 2),during internal fixation(T 3)and after surgery(T 4)were compared.Their postoperative awakening time,extubation time,dosages of intraoperative propofol and remifentanil,visual analogue scale(VAS)scores at 12 h and 24 h after surgery,and levels of pain mediators[serumβ-endorphin(β-EP)and calcitonin gene-related peptide(CGRP)]before surgery,at 24 h and on day 3 after surgery were also compared between two groups.Results HR and MAP at T 2,T 3 and T 4 in both groups were higher than those at T 1,but lower in the observation group than those in the control group(P<0.001).The postoperative awakening time and extubation time of the observation group were shorter than those of the control group,and the intraoperative dosages of propofol and remifentanil were lower than that of the control group(P<0.001).The VAS scores in the observation group at 12 h and 24 h after surgery were lower than those in control group(P<0.001).The serumβ-EP and CGRP levels in the observation group at 24 h and on day 3 after operation were lower than those in the control group(P<0.001).Conclusion The application of ultrasound-guided femoral nerve and popliteal approach sciatic nerve block combined with general anesthesia in the treatment of patient

关 键 词：超声引导 神经阻滞 麻醉 全身 胫骨骨折 

分 类 号：R614.1[医药卫生—麻醉学]