超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻在老年患者大隐静脉曲张手术中的应用  

Application of ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask in elderly patients undergoing surgery for great saphenous varicose veins

作　　者：徐方胜 马舒玉 刘容光 王梅芳 濮健峰 XU Fangsheng;MA Shuyu;LIU Rongguang;WANG Meifang;PU Jianfeng(Department of Anesthesiology,Affiliated Changshu Hospital of Nantong University,Changshu 215500,China)

机构地区：[1]南通大学附属常熟医院麻醉科,江苏常熟215500

出　　处：《新医学》2024年第9期722-728,共7页Journal of New Medicine

基　　金：常熟市卫生健康委员会科技计划项目(sws202011)。

摘　　要：目的探讨超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全身麻醉(全麻)在老年患者大隐静脉曲张手术中的应用价值。方法选取择期行单侧大隐静脉高位结扎点式剥脱联合激光闭合术的老年患者60例,随机分为A组(单纯喉罩全麻)和B组(超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻),每组30例。记录术中麻醉药物用量、血流动力学波动和喉罩拔除时间;评估术后静态和动态疼痛视觉模拟量表(VAS)评分、15项恢复质量(QoR-15)评分、简易智力状态检查(MMSE)评分以及不良反应情况,并进行比较。结果B组术后24 h QoR-15和MMSE评分均高于A组(P均<0.05);A组切皮时的平均动脉压和心率均高于B组(P均<0.05);B组术后5 min、30 min、6 h、12 h静态和动态疼痛VAS评分均低于A组(P均<0.05);B组丙泊酚用量、瑞芬太尼用量及喉罩拔除时间均低于A组,差异均有统计学意义(P均<0.05)。结论超声引导下腹股沟韧带上髂筋膜阻滞联合喉罩全麻可改善患者术后恢复质量和认知功能,减少麻醉药物用量,缩短拔管时间,增强血流动力学稳定性,减轻术后疼痛,从而促进快速康复。Objective To evaluate the application value of ultrasound-guided suprainguinal iliaca fascia block combined with general anesthesia with laryngeal mask in elderly patients undergoing surgery for the great saphenous varicose veins.Methods Sixty elderly patients scheduled for unilateral high ligation and stripping of the great saphenous veins combined with endovenous laser ablation were randomly divided into Group A(general anesthesia with laryngeal mask alone,n=30)and Group B(ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask,n=30).Intraoperative anesthetic consumption,hemodynamic fluctuations,and laryngeal mask removal time were recorded.Postoperative changes in static and dynamic Visual Analogue Scale(VAS)pain scores,15-item Quality of Recovery(QoR-15)scores,Mini-Mental State Examination(MMSE)scores,and adverse events were also evaluated.Results The QoR-15 and MMSE scores at postoperative 24 h in Group B were significantly higher than those in Group A(both P<0.05).The mean arterial pressure(MAP)and heart rate(HR)during skin incision in Group A were significantly higher than those in Group B(both P<0.05).The static and dynamic VAS pain scores at postoperative 5 min,30 min,6 h,and 12 h in Group B were significantly lower compared to those in Group A(all P<0.05).In Group B,the consumption of propofol and remifentanil was significantly less,and the laryngeal mask removal time was significantly shorter than those in Group A,with statistically significant differences(both P<0.05).Conclusion Ultrasound-guided suprainguinal fascia iliaca block combined with general anesthesia with laryngeal mask improves postoperative quality of recovery and cognitive function,reduces anesthetic consumption,shortens extubation time,enhances hemodynamic stability and alleviates postoperative pain,thereby promoting rapid recovery.

关 键 词：腹股沟韧带上髂筋膜阻滞 老年患者 大隐静脉曲张 术后恢复质量 喉罩全麻 

分 类 号：R614[医药卫生—麻醉学]