B超引导下下肢神经阻滞复合喉罩全麻在老年患者人工全髋置换手术中的应用

Application of B-mode ultrasound guided lower extremity nerve block combined with laryngeal mask anesthesia in elderly patients receiving total hip replacement

目的:探讨超声引导下下肢神经阻滞在老年患者人工全髋置换术中的应用。方法:选取某院行人工全髋置换术的老年患者40例,依据麻醉方式不同,随机分为G组(喉罩全麻组)和N组(神经阻滞复合喉罩全麻组),每组各20例。分别记录2组患者麻醉诱导前(T1)、诱导后(T2)、切皮时(T3)和术毕时(T4)的平均动脉压(MAP)、心率(HR)、苏醒时间、苏醒期躁动情况及术后24 h内单次按压追加镇痛泵药物的次数。结果:G组患者T2,T3和T4时间点的MAP以及HR与T1比较,波动显著,差异有统计学意义(P<0.01);N组患者T2,T3和T4时间点的MAP以及HR与T1比较,波动较小,差异无统计学意义(P>0.05);2组患者苏醒时间、苏醒期躁动情况、术后24 h内单次按压追加镇痛药物的次数比较,差异有统计学意义(P<0.01)。结论:超声引导下下肢神经阻滞复合喉罩全麻可安全用于老年患者人工全髋置换术,术中血流动力学平稳,术后苏醒快速,苏醒质量佳,镇痛效果确切满意。

Objective：To investigate the advantages and disadvantages of ultrasonic guided unilateral lower extremiU nerve block （ simultaneously blocking the femoral and lateral femoral cutaneous nerve, obturator nerve and sciatic nerve ） in elderly patients receiv- ing total hip replacement. Methods ： 40 elderly patients receiving total hip replacement in a hospital were selected and randomly divided into group G （ laryngeal general anesthesia group ） and group N （ nerve block combined with laryngeal mask anesthesia ） according to the different methods of anesthesia selected,20 cases in each group. The mean arterial pressure （MAP）, heart rate （HR）, awakening time and the restlessness in the awakening period were recorded in the two groups. MAP and HR were recorded at the points of pre-an- esthesia induction （ T~ ）, post-anesthesia induction （ T2 ）, excision of skin （ T3 ） and surgical sutures （ T4 ）. The number of additional analgesics by single pressing during 24 hours after the operation was recorded. Results ： MAP and HR at the points of T2 , T3 and T4 were significantly fluctuated compared with those at the point of T1 in group G, and the difference was statistically significant （ P 〈 0. 05 ）. The fluctuation of MAP and HR at the points of T2 , T3 and T4 in group N was smaller and the difference was not statistically significant compared with T1 （ P 〉 0.05 ）. The awakening time, the patients＇restlessness and the number of additional analgesics by sin- gle pressing during 24 hours after the operation in group N were statistically significant compared with those in group G （ P 〈 0.05 ）. Conclusion：The ultrasonic guided nerve block combined with laryngeal mask general anesthesia can be safely used for total hip re- placement in elderly patients. The hemodynamics of the patients is stable, the recovery is fast after the operation, the quality- of awak- ening is satisfactory, and the analgesic effect is accurate.