喉罩全麻复合腰丛-坐骨神经阻滞应用于老年患者全膝关节置换术的临床观察

Clinical Observation of General Anesthesia Combined with Lumbar Plexus and Sciatic Nerve Block in Total Knee Arthroplasty in Elderly Patients

目的:探讨喉罩全麻复合腰丛-坐骨神经阻滞应用于老年患者全膝关节置换术的临床效果。方法:收集2014年6月至2017年6月入院的111例行全膝关节置换术患者随机分为两组,A组患者给予喉罩全麻,B组患者复合腰丛-坐骨神经阻滞,比较两组患者围手术期监测指标、术后疼痛、舒适度、镇静、炎性指标、丙泊酚维持药量与药物不良反应率。结果:B组患者T2、T3与T4时期的SBP与MAP水平组间比较均低于A组,T3与T4时期的HR水平低于A组;术后24h与48h的VAS评分组间比较低于A组,BCS评分与RSS评分高于A组;12h、24h与48h的CRP水平低于A组;8h、2h、24h与48h的IL-6水平低于A组;丙泊酚维持药量低于A组,差异存在统计学意义(P<0.01);两组患者各药物不良反应率均差异不存在统计学意义(P>0.05)。结论:喉罩全麻复合腰丛联合坐骨神经阻滞应用于老年患者全膝关节置换术的临床效果显著,具有借鉴意义。

Objective: To investigate the clinical effect of laryngeal mask general anesthesia combined with lumbar plexus-sciatic nerve block in total knee arthroplasty. Methods: 111 patients undergoing total knee arthroplasty were enrolled from June 2014 to June 2017 were randomly divided into two groups. Group A patients were given laryngeal mask general anesthesia,group B patients with complex lumbar plexus-sciatic nerve block Perioperative monitoring of two groups of patients,postoperative pain,comfort,sedation,inflammatory indicators,propofol maintenance dose and adverse drug reaction rate. Results: The levels of SBP and MAP in group B were significantly lower than those in group A at T2,T3 and T4. The HR level of T3 and T4 was significantly lower than that of group A; the VAS score group at 24 h and 48 h The scores of 12 h,24 h and48 h were significantly lower than those of group A,and the levels of IL-6 at 8 h,2 h,24 h and 48 h were significantly lower than those in group A( P <0.01). There was no significant difference in the adverse reaction rate between the two groups( P > 0.05). There was no significant difference between the two groups( P > 0.05).Conclusion: Laryngeal mask general anesthesia combined with lumbar plexus combined with sciatic nerve block in elderly patients with total knee arthroplasty clinical effect is significant,with reference.