超声引导坐骨神经阻滞联合喉罩全身麻醉用于胫骨骨折手术

Sciatic Nerve Block Guided by Ultrasound in Combination with Laryngeal Mask General Anesthesia for Tibial Fracture Surgery

目的:研究胫骨骨折手术应用超声引导坐骨神经阻滞联合喉罩全身麻醉的效果。方法:选取2017年8月～2018年3月本院接收的行手术治疗的胫骨骨折患者90例,根据不同的麻醉方式分为两组,观察组(n=45)与对照组(n=45)。观察组手术时采用超声引导坐骨神经阻滞联合喉罩全身麻醉,对照组采用喉罩全身麻醉,对比两组患者的麻醉效果。结果:观察组的瑞芬太尼用量、拔喉罩时(T2)与拔喉罩10 min后(T3)的心率(HR)、T2与T3时间段的平均动脉压(MAP)均明显优于对照组,组间比较差异有统计学意义(P<0.05);观察组术后0.5、2、4、8、16、24 h VAS评分均小于对照组,差异有统计学意义(P<0.05);观察组PCIA按压次数低于对照组,PCIA剩余量高于对照组,恶心呕吐不良反应发生率低于对照组,镇痛满意度高于对照组,差异均有统计学意义(P<0.05)。结论:在胫骨骨折手术中应用超声引导坐骨神经阻滞联合喉罩全身麻醉,可以提高麻醉效果、降低并发症发生率,镇痛效果较好,同时也具有较高的安全性。

Objective: To study the effect of ultrasound-guided sciatic nerve block combined with laryngeal mask general anesthesia for tibial fracture surgery. Methods: Selected 90 cases in our hospital from August 2017 to March 2018, were received the tibial fracture surgery, according to the different anesthesia methods they were divided into two groups, the observation group(n=45) and the control group(n= 45). Laryngeal mask general anesthesia and sciatic nerve block guided by ultrasound were applied in the observation group,laryngeal mask general anesthesia was applied in the control group, to explore the anesthesia effect of two groups. Results: The remifentanil dose, heart rate at T2 and T3 time periods and mean arterial pressure at T2 and T3 time points in the observation group were significantly better than those in the control group, there were statistically significant differences between the two groups(P<0.05). The VAS pain scores of 0.5, 2, 4, 8, 16 and 24 hours were significantly lower than those in the control group, there were statistically significant differences between the two groups(P<0.05);PCIA compressions times, incidence of nausea and vomiting in the observation group were lower than in the control group, PCIA residual and analgesic satisfaction were higher than the control group, there were statistically significant differences between the two groups(P<0.05). Conclusion: Application of sciatic nerve block guided by ultrasound combined laryngeal mask general anesthesia in tibial fracture surgery can improve the effect of anesthesia, reduce the incidence of complications,analgesic effect is better, also has higher security.