超声引导下股神经阻滞复合小剂量瑞芬太尼麻醉在高龄患者膝关节镜手术中的应用

Application of Ultrasound-Guided Femoral Nerve Blockade Combined With Small Dose of Remifentanil in Knee Arthroscopic Surgery of Elderly Patients

目的探讨超声引导下股神经阻滞复合小剂量瑞芬太尼麻醉在高龄患者膝关节镜手术中的应用效果。方法通过随机数字表法将我院2014年3月至2016年8月收治的40例高龄开展膝关节镜手术的患者分为实验组(超声引导下股神经阻滞复合小剂量瑞芬太尼组,n=20)和对照组(静脉全身麻醉组,n=20)。两组患者进入手术室前均无相关用药,对各组患者术中最高VAS评分及患者满意度进行统计分析,观察记录术中患者痛感情况及相关体动。记录瑞芬太尼输注速率及药物、操作过程中患者并发症发生情况。结果实验组瑞芬太尼输入速率、VAS最高评分及术中体动发生率同对照组相比降低明显,同时麻醉效果及患者满意度同对照组相比则明显提高(P<0.05)。经过对比两组在操作中部分不良反应的发生率显著降低(P<0.05),瘙痒和肌强直情况等不良反应的发生率在两组中的比较差异无统计学意义(P>0.05)。结论超声引导下股神经阻滞复合小剂量瑞芬太尼麻醉用于高龄患者膝关节镜手术可显著降低术中镇静、镇痛药物的使用剂量及相关不良反应发生率,显著改善了老年患者围手术期的安全性及舒适性,此方案可推广普及用于高龄患者的手术麻醉。

Objective To observe the application of ultrasound-guided femoral nerve blockade combined with small dose of remifentanil in knee arthroscopic surgery of elderly patients.Methods 40 cases of elderly patients undergoing knee arthroscopic surgery from March 2014 to August 2016 in our hospital were retrospectively analyzed.The patients were divided into experimental group and control group according to the random number table method,20 cases each group.The control group received intravenous general anaesthesia treatment;the experimental group received ultrasound-guided femoral nerve blockade combined with small dose of remifentanil treatment.Following variables were recorded：visual analog scale（VAS）of pain,infusion rate of remifentanil,satisfaction scoring and adverse reaction.Results Compared with control group,patients in experimental group had lower VAS pain scores,slower infusionrate of remifentanil,fewer adverse reactions and higher sarisfaction（P〈 0.05 or P 〈0.01）.Conclusion Ultrasound-guided femoral nerve blockade combined with small dose of remifentanil is an effective and safety anesthetic means in patients undergoing knee arthroscopic surgery in elderly patients.