双侧股神经阻滞复合全身麻醉在双膝关节置换术中的应用效果  

Application effect of bilateral femoral nerve block combined with general anesthesia in double knee arthroplasty

作　　者：于淼 尚宇 YU Miao;SHANG Yu(Department of Anesthesiology,Central Hospital Affiliated to Shenyang Medical College,Liaoning Province,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院麻醉科,辽宁沈阳110024

出　　处：《中国当代医药》2021年第1期166-169,共4页China Modern Medicine

摘　　要：目的探讨双膝关节置换术中双侧股神经阻滞复合全身麻醉的应用价值。方法选取2018年8月~2019年8月在沈阳医学院附属中心医院拟行双膝关节置换术的68例患者作为研究对象,依据随机数字表法分为对照组(n=34)和观察组(n=34)。对照组患者行全身麻醉,观察组患者行双侧股神经阻滞复合全身麻醉,观察两组患者术中不同时间段的心率(HR)、平均动脉压(MAP)变化、麻醉药物使用情况、意识恢复时间、拔管时间及围术期不良反应发生率。结果两组患者麻醉前(T1)、气管插管即刻(T2)、止血带开始5 min(T3)、停用止血带5 min(T4)及拔除气管导管即刻(T5)的HR、MAP比较,差异均无统计学意义(P>0.05)。两组患者T2、T3、T4时刻的HR、MAP低于T1,差异有统计学意义(P<0.05);观察组患者的丙泊酚、瑞芬太尼使用量均少于对照组,意识恢复时间及拔管时间均短于对照组,视觉模拟疼痛评分(VAS)低于对照组(P<0.05);观察组患者的降压药或降心率药物使用率、拔管呛咳发生率、苏醒期躁动率及拔管后切口疼痛率均低于对照组(P<0.05)。结论双侧股神经阻滞复合全身麻醉应用于双膝关节置换术中能够维持患者血流动力学的稳定,减少患者静脉镇痛药物和阿片类镇痛药物的使用,同时又能缩短患者意识恢复时间及拔管时间,缓解患者术后疼痛,降低并发症的发生风险。Objective To explore the application value of bilateral femoral nerve block combined with general anesthesia in double knee arthroplasty.Methods A total of 68 patients who were scheduled to undergo double knee arthroplasty in Central Hospital Affiliated to Shenyang Medical College from August 2018 to August 2019 were selected as the research objects.The patients were divided into the control group(n=34)and the observation group(n=34)according to the random numerical table method.The patients in the control group received general anesthesia,while the patients in the observation group received bilateral femoral nerve block combined with general anesthesia.The changes of different intraoperative periods of heart rate(HR),mean arterial pressure(MAP),narcotic drug use,consciousness recovery time,extubation time and perioperative adverse reactions in the two groups were observed.Results There were no significant differences in HR and MAP between the two groups before anesthesia(T1),immediately after tracheal intubation(T2),5 min after tourniquet was started(T3),5 min after tourniquet was stopped(T4)and immediately after tracheal catheter was pulled out(T5)(P>0.05).The levels of HR,MAP at T2,T3 and T4 of patients of the two groups were lower than those at T1,and the differences were statistically significant(P<0.05).The dosages of Propofol and Remifentanil in the observation group were less than those in the control group,the recovery time of consciousness and extubation time in the observation group were shorter than those in the control group,and the visual analogue pain score(VAS)in the observation group was lower than that in the control group(P<0.05).The usage rate of antihypertensive drugs or heart rate reducing drugs,the incidence rate of choking cough after extubation,the agitation rate during awakening period and the incision pain rate after extubation in the observation group were lower than those in the control group(P<0.05).Conclusion The application of bilateral femoral nerve block combined with general ane

关 键 词：双膝关节置换术 双侧股神经阻滞 复合全身麻醉 应用价值 

分 类 号：R614.4[医药卫生—麻醉学]