超声引导神经阻滞复合全身麻醉在老年患者膝关节置换术手术中的应用

Application of Ultrasound-guided Nerve Block Combined with General Anesthesia in Elderly Patients with Knee Replacement Surgery

目的探讨超声引导神经阻滞复合全身麻醉在老年患者膝关节置换术中的应用效果。方法将整群选取2013年1月—2015年12月在该院行膝关节置换术的64例老年患者随机分为2组（各组32例）,对照组采用喉罩置入静吸复合全身麻醉,联合组采用超声引导神经阻滞复合全身麻醉。比较两组患者麻醉各时刻的血流动力学变化、术后疼痛程度等。结果联合组的舒芬太尼追加剂量、总量,静脉镇痛自控用药总量分别为（5±5）μg、（15±5）μg、（66.2±3.8）μg,均明显少于对照组的（35±10）μg、（50±10）μg、（92.2±5.8）μg,P〈0.05;联合组t2~t4时刻的MAP值均显著低于对照组,t2、t3时刻的HR值均显著低于对照组,P〈0.05;联合组术后2 h、24 h的VAS评分分别为（0.6±0.2）分、（2.1±0.7）分,对照组分别为（2.2±0.6）分、（4.2±1.1）分,组间比较差异均有统计学意义（P〈0.05）。联合组与对照组术后的恶心呕吐发生率分别为12.50%（4/32）、3.13%（1/32）,组间比较差异均有统计学意义（P〈0.05）。结论在老年膝关节置换术中采用超声引导神经阻滞复合全身麻醉方式,能够较好地维持血流动力学稳定性,减少术中、术后镇痛药物的使用,并且不会增加麻醉不良反应,是一种安全、有效的麻醉方式。

Objective To evaluate ultrasound-guided nerve block combined with general anesthesia in elderly patients with knee arthroplasty application effect. Methods From 2013 January to 2015 December in our hospital underwent knee arthro-plasty 64 cases of elderly patients were divided to 2 groups （32 cases）, control group was treated with laryngeal mask inser-tion of Intravenous Inhalation Combined with general anesthesia, combined group by ultrasonic guided nerve block com-bined with general anesthesia. The changes of hemodynamics and postoperative pain were compared between the two groups. Results Respectively, were an additional dose of sufentanil combined group, total intravenous patient-controlled analgesia dose （5±5） μg, （15±5） μg, （66.2±3.8） μg were significantly less than control group （35±10） μg, （50±10） μg, （92.2±5.8） μg, P﹤0.05. The combined group of t2~t4 map value was significantly lower than that of control group, T2, T3 HR values were significantly lower than those of the control group, P﹤ 0.05; the combined group after 2h, 24h, the VAS score （0.6± 0.2） and （2.1±0.7）, the control group respectively （2.2±0.6）, （4.2±1.1）, the group had significant difference （P﹤ 0.05）. The inci-dence of postoperative nausea and vomiting in combination group and control group were 12.50% （4/32）, 3.13% （1/32）, and there were significant differences among groups （P﹤0.05）. Conclusion The use of ultrasound-guided nerve block combined with general anesthesia, better able to maintain hemodynamic stability, reduce intraoperative, postoperative pain medication use in the elderly knee replacement surgery, and will not increase the adverse anesthesia the reaction is a safe and effective anesthesia.