超声引导踝神经阻滞麻醉对老年阿尔茨海默病患者踝远端手术的效果观察  

EFFECT OF ULTRASOUNDS GUIDED ANKLE NERVE BLOCK ANESTHESIA ON DISTAL ANKLE SURGERY IN ELDERLY PATIENTS WITH ALZHEIMER’S DISEASE

作　　者：王小锐[1] 李阳阳[2] 万亮[1] WANG Xiaorui;LI Yangyang;WAN Liang(Anesthesiology,The Second Hospital of Tangshan,Tangshan 063000,China;不详)

机构地区：[1]河北省唐山市第二医院麻醉科,063000 [2]河北省唐山市协和医院耳鼻喉科

出　　处：《中国煤炭工业医学杂志》2021年第2期148-152,共5页Chinese Journal of Coal Industry Medicine

基　　金：2015年度河北省医学科学研究重点课题计划项目(编号:20150929)。

摘　　要：目的观察超声引导下踝部神经阻滞麻醉在老年阿尔茨海默病患者踝远端手术中的麻醉效果和对血流动力学的影响。方法回顾性分析唐山市第二医院2010年1月—2019年1月收治的进行踝部神经阻滞的患者62例,34例患者实施超声引导的踝部神经阻滞(A组),28例患者实施硬膜外麻醉(B组),二组均静脉给予盐酸右美托咪定1μg/kg持续泵入,泵入时间12 min,待患者处于完全镇静即深睡眠状态后给予静脉盐酸右美托咪定0.7~0.8μg/(kg·h)持续泵入,维持镇静状态,记录动脉穿刺置管完后1 min(T0)、局麻药注射完成后5 min(T1)、手术切皮即刻(T2)、手术开始后15 min(T3)、30 min(T4)、手术结束苏醒即刻(T5)时的HR、MAP,分析血流动力学变化,并通过镇静评分和观察应激性体动反应评估麻醉效果是否完善。结果A组在所有时间点镇静评分均达到0分,无1例应激性体动;B组在T2时间点有4例镇静评分为1分,并出现应激性体动,差异均无统计学意义(均P>0.05)。血流动力学方面,二组在T0、T3、T4、T5时HR、MAP差异无统计学意义(P>0.05);T1、T2时A组HR明显低于B组、MAP明显高于B组,差异有统计学意义(P<0.05)。结论老年阿尔茨海默病患者行足踝远端手术中,应用右美托咪定镇静后实施超声引导下踝部神经阻滞,麻醉效果确切、完善,对患者血流动力学影响极小,具有较高的安全性。Objective To observe the effect of ultrasound guided ankle nerve block anesthesia on distal ankle surgery in elderly patients with Alzheimer’s disease and its effect on hemodynamics.Methods We retrospectively analyzed sixty-two patients who needed ankle nerve block admitted to Tangshan Second Hospital from 2010 to 2019,thirty-four patients received ultrasound-guided ankle nerve block(group A),and 28 patients received epidural anesthesia(group B).1μg/kgdexmedetomidine hydrochloride was continuously pumped intravenously in both groups for 12 minutes.After the patient was in deep sleep,0.7~0.8μg/(kg·h)dexmedetomidine hydrochloride was continuously pumped intravenously to maintain sedation.The vital signs,such as HR and MAP,were recorded 1 min after the arterial puncture and catheterization(T0),5 min after the local anesthetic injection(T1),immediately after the surgical peeling(T2),15 min(T3)and 30 min(T4)after the beginning of the operation,and immediately after the end of the operation,to analyze the hemodynamic changes and observe whether the anesthetic effect was perfect.Results The sedation score of group A reached 0 at all time points,and no stress body movement was found in group A,differences had no statistical significance(P>0.05).Four patients in group B had a sedation score of 1 and showed stress body movement at time 2.In terms of hemodynamics,there were no significant differences in HR and MAP between the two groups at T0,T3,T4 and T5(P>0.05).At T1 and T2,the HR in group A was significantly lower than that in group B,and the MAP in group A was significantly higher than that in group B,with statistical significance(P<0.05).Conclusion Elderly alzheimer’s patients in the distal row ankle surgery operation,application right beautiful Joe cannot be calm after the implementation of the ankle nerve block guided by ultrasound,the anesthesia effect is exact,perfect,influence on hemodynamics in patients with tiny has higher security.

关 键 词：超声引导 踝神经阻滞 老年阿尔茨海默病 

分 类 号：R686[医药卫生—骨科学]