超声引导下股神经阻滞复合全身麻醉在老年全膝关节置换术中的应用

Application of ultrasound guided femoral nerve block combined with general anesthesia in elderly patients with total knee arthroplasty

目的探讨超声引导下股神经阻滞复合全身麻醉在老年患者全膝关节置换(TKA)术中的应用,评价其实用性和安全性。方法选择择期行单侧TKA的老年患者60例,随机分为A、B组,每组30例,A组行全身麻醉,B组全身麻醉后行超声引导下股神经阻滞。记录2组患者丙泊酚、瑞芬太尼用量、苏醒时间、拔管时间。采用视觉模拟疼痛(VAS)评分法,评估2组术后30 min、2 h、4 h、8 h的疼痛强度及相关并发症,记录术后24 h患者满意度。结果 B组患者丙泊酚和瑞芬太尼用量明显少于A组(P<0.05),B组的苏醒时间和拔管时间也短于A组(P<0.05)。B组拔管后30 min以及术后2 h、4 h、8 h VAS评分均低于A组,差异有统计学意义(P<0.05)。B组术后24 h的患者满意度高于A组。结论超声引导下股神经阻滞复合全身麻醉用于老年患者TKA,可减少术中全麻药用量,有利于患者早日苏醒,减轻患者的早期术后疼痛,镇痛效果确切,不良反应少,值得临床推广。

Objective To investigate the application of ultrasound guided femoral nerve block combined with general anesthesia in the elderly patients with total knee arthroplasty（ TKA）,and to evaluate its practicability and safety.Methods Sixty patients with unilateral TKA were randomly divided into two groups,with 30 cases in each group. Patients in group A received general anesthesia,and group B was treated with ultrasound guided femoral nerve block combined with general anesthesia. The dosage of propofol,remifentanil,and the time of recovery and extubation were recorded and compared in the two groups. Pain intensity was evaluated by visual analog pain score（ VAS）,and the scores of 30 min,2 h,4h and 8 h after operation and the degree of satisfaction 24 h after the operation in two groups were observed and compared.Results The dosage of propofol and remifentanil in group B was significantly less than that in group A（ P〈0. 05）,and the recovery time and extubation time of group B were shorter than those in group A（ P〈0. 05）. After 30 min and 2 h,4 h,8 h,VAS score of group B was lower than that of group A（ P〈0. 05）. The degree of satisfaction 24 h after the operation in group B was significantly higher than that in group A. Conclusions Ultrasound guided femoral nerve combined with general anesthesia for elderly patients with TKA could reduce intraoperative anesthetics dosage,improving early awaking,reducing early postoperative pain,with less adverse reactions.