超声引导下股神经及坐骨神经阻滞联合喉罩全身麻醉对老年下肢烧伤手术患者术后苏醒及镇痛的影响  

Effects of Ultrasound-Guided Femoral and Sciatic Nerve Block Combined with Laryngeal Mask General Anesthesia on Postoperative Recovery and Analgesia in Elderly Patients Undergoing Surgery for Lower Extremity Burns

作　　者：刘珍 张学康[1] 龚玉荣 LIU Zhen;ZHANG Xue-kang;GONG Yu-rong(Department of Anesthesiology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Anesthesiology,Jinxian County People’s Hospital,Nanchang 331700,China)

机构地区：[1]南昌大学第一附属医院麻醉科,南昌330006 [2]进贤县人民医院麻醉科,江西进贤331700

出　　处：《实用临床医学（江西）》2023年第1期14-17,共4页Practical Clinical Medicine

基　　金：江西省基层卫生适宜技术“星火推广计划”项目(20208014)。

摘　　要：目的观察超声引导下股神经及坐骨神经阻滞联合喉罩全身麻醉对老年下肢烧伤手术患者术后苏醒及疼痛的影响。方法将择期行单侧下肢烧伤手术老年患者40例随机分为观察组和对照组,每组20例。观察组在超声引导下行股神经及坐骨神经阻滞联合喉罩全身麻醉,对照组行单纯喉罩全身麻醉。观察2组入室时(T1)、插喉罩即刻(T2)、手术开始时(T3)、拔除喉罩即刻(T4)各时点平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO_(2))的变化;记录2组术中麻醉药物用量、术后苏醒时间、拔管时间、苏醒期躁动及嗜睡等情况;术后1、2、6、8、12、24 h采用视觉模拟评分法(VAS)评价2组患者的疼痛程度。结果与对照组比较,观察组T3、T4时点HR、MAP值,术中瑞芬太尼、丙泊酚及顺式阿曲库铵用量,术后苏醒时间、拔管时间,苏醒期躁动、嗜睡发生率,术后1、2、6、8、12、24 h VAS评分均显著减少,差异有统计学意义(P<0.001)。结论超声引导下股骨神经及坐骨神经阻滞联合喉罩全身麻醉用于老年下肢烧伤手术患者具有麻醉药用量少、血流动力学影响小、术后苏醒质量高、术后疼痛程度轻等优点,有利于患者的术后恢复。Objective To observe the effects of ultrasound-guided femoral and sciatic nerve block combined with laryngeal mask general anesthesia on postoperative recovery and pain in elderly patients undergoing surgery for lower extremity burns.Methods Forty elderly patients scheduled for unilateral lower extremity burn surgery were randomly assigned to receive laryngeal mask general anesthesia alone(control group,20 patients)or in combination with ultrasound-guided femoral and sciatic nerve block(observation group,20 patients).Mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO_(2))were measured at admission to operating room(T1),immediately after insertion of laryngeal mask(T2),at the beginning of operation(T3),and immediately after removal of laryngeal mask(T4).Intraoperative anesthetic dosage,postoperative recovery time,extubation time,restlessness and lethargy during recovery were recorded.Visual analog scale(VAS)was used to evaluate the pain degree at 1,2,6,8,12,and 24 hours after operation.Results Compared with the control group,HR and MAP at T3 and T4,intraoperative dosages of remifentanil,propofol and cis-atracurium,postoperative recovery time,extubation time,incidence of restlessness and lethargy during recovery,and VAS scores at 1,2,6,8,12 and 24 hours after operation significantly decreased in the observation group(P<0.001).Conclusion Ultrasound-guided femoral and sciatic nerve block combined with laryngeal mask general anesthesia can reduce anesthetic dosage,stabilize hemodynamics,improve postoperative recovery quality,relieve postoperative pain,and promote postoperative recovery in elderly patients undergoing surgery for lower extremity burns.

关 键 词：超声引导 神经阻滞 喉罩全身麻醉 下肢烧伤手术 老年人 

分 类 号：R614[医药卫生—麻醉学]