股神经阻滞联合股动脉旁阻滞对老年患者全膝关节置换术中止血带高血压反应的影响  

Effect of femoral nerve block combined with femoral para-arterial block on tourniquet-induced hypertension in the elderly receiving total knee arthroplasty

作　　者：夏玉中 王海涛[1] 宋广东[1] 袁静静[1] 王中玉[1] XIA Yuzhong;WANG Haitao;SONG Guangdong;YUAN Jingjing;WANG Zhongyu(Department of Anesthesiology,Peroperative and Pain Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围手术期及疼痛医学部,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2024年第11期1093-1097,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(82371235)。

摘　　要：目的探讨行全膝关节置换术(TKA)的老年患者应用超声引导下股神经阻滞联合股动脉旁阻滞在减轻止血带高血压反应(TH)中的作用。方法2023年2—11月郑州大学第一附属医院择期全身麻醉下行单侧TKA患者72例,随机分为对照组和观察组各36例。2组采用相同的全身麻醉方案。麻醉诱导前30 min,2组于超声引导下在股神经鞘内注射体积分数0.25%罗哌卡因15 mL后,对照组在股动脉前内侧、后外侧各注射生理盐水5 mL,观察组在股动脉前内侧、后外侧各注射体积分数0.25%罗哌卡因5 mL。比较2组止血带使用时间、止血带压力、TH发生率及艾司洛尔、瑞芬太尼、舒芬太尼用量;记录2组麻醉前(T_(0))、上止血带前1 min(T_(1))、上止血带后10 min(T_(2))、上止血带后30 min(T_(3))、上止血带后60 min(T_(4))、松止血带前1 min(T_(5))、松止血带后5 min(T_(6))时的收缩压(SBP)、平均动脉压(MAP)和心率;2组分别在T_(1)、T_(5)及松止血带后15 min(T_(7))留取动脉血,检测肾上腺素、去甲肾上腺素、多巴胺浓度。结果(1)观察组TH发生率(22.22%)低于对照组(69.44%)(χ^(2)=16.160,P<0.001),艾司洛尔用量[(21.18±34.59)mg]少于对照组[(68.69±47.16)mg](t=4.870,P<0.001),止血带使用时间、止血带压力、瑞芬太尼用量、舒芬太尼用量与对照组比较差异均无统计学意义(P>0.05)。(2)观察组、对照组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)时SBP、MAP、心率比较差异均有统计学意义(观察组:F=47.020、81.600、29.080,P均<0.001;对照组:F=117.97、247.600、115.400,P均<0.001)。观察组、对照组T_(3)[(126.89±5.23)、(127.28±5.93)mmHg]、T_(4)[(130.45±8.97)、(138.60±4.64)mmHg]、T_(5)[(136.48±8.77)、(150.25±5.46)mmHg]时SBP均高于T_(0)时[(116.89±6.03)、(117.31±6.61)mmHg](P<0.05),T_(2)[(70.54±4.44)、(71.54±3.54)mmHg]、T_(3)[(75.54±3.23)、(75.56±3.69)mmHg]、T_(4)[(78.12±3.64)、(85.79±6.37)mmHg]、T_(5)[(83.78±4.01)、(98.26±4.79)mObjective To explore the role of femoral nerve block plus femoral para-arterial block on tourniquet-induced hypertension(TH)in elderly patients undergoing total knee arthroplasty(TKA).Methods Seventy-two patients were electively performed unilateral TKA under general anesthesia in the First Affiliated Hospital of Zhengzhou University from February to November 2023,and were randomly and equally divided into control group and observation group.Two groups were given injection of 15 mL of 0.25%ropivacaine into the femoral nerve sheath under ultrasound guidance30 min before anesthesia induction,while the patients in control group were subsequently injected with 5 mL of normal saline and the patients in observation group were subsequently injected with 5 mL of 0.25%ropivacaine into the femoral artery anteromedial and posterolateral areas.The duration of tourniquet use,tourniquet pressure,TH ircideice,esmolol dosage,remifentanil dosage and sufentanil dosage were compared between two groups.The systolic blood pressure(SBP),mean arterial pressure(MAP)and heart rate were recorded before anesthesia(T_(0)),1 min before tourniquet inflation(T_(1)),10 min after tourniquet inflation(T_(2)),30 min after tourniquet inflation(T_(3)),60 min after tourniquet inflation(T_(4)),1 min before tourniquet deflation(T_(5))and 5 min after tourniquet deflation(T_(6)).The arterial blood samples were collected at T_(1),T_(5) and 15 min after tourniquet deflation(T_(7))to detect the concentrations of epinephrine,norepinephrine and dopamine.Results(1)The incidence of TH was lower in observation group(22.22%)than that in control group(69.44%)(χ^(2)=16.160,P<0.001),the esmolol requirement was less in observation group[(21.18±34.59)mg]than that in control group[(68.69±47.16)mg](t=4.870,P<0.001),and there were no statistically significant differences in the duration of tourniquet use,tourniquet pressure,remifentanil and sufentanil consumptions between two groups(P>0.05).(2)There were statistically significant differences in the SBPs,MAPs and heart

关 键 词：全膝关节置换术 止血带高血压反应 股动脉旁阻滞 股神经阻滞 

分 类 号：R614[医药卫生—麻醉学]