外周神经阻滞麻醉在老年单膝关节置换术中的应用

Peripheral Nerve Block Anesthesia in Elderly Patients Undergoing Single Knee Arthroplasty

目的分析外周神经阻滞麻醉在老年单膝关节置换术中的应用价值。方法选取2016年4月至2018年3月于武汉市黄陂区人民医院行单膝关节置换术的90例老年患者为研究对象,根据所用麻醉方式不同分为对照组和观察组,各45例。对照组采用腰硬联合麻醉,观察组采用外周神经阻滞麻醉,比较两组患者的麻醉情况及不同时点间血流动力学变化。结果观察组麻醉起效时间和阻滞完善时间长于对照组[(3.05±0.10)min比(1.66±0.08)min、(16.53±0.44)min比(5.97±0.76)min](P<0.01)。对照组不同时点心率、血压、血氧饱和度波动幅度较大,观察组不同时点心率、血压、血氧饱和度均较平稳,两组各指标组间、时点间、组间和时点间交互作用比较差异均有统计学意义(P<0.01)。术后24 h和72 h,观察组VAS评分低于对照组,MMSE评分高于对照组(P<0.05)。观察组总不良反应发生率低于对照组[2.22%(2/45)比15.56%(7/45)](P<0.01)。结论老年单膝关节置换术患者实施外周神经阻滞麻醉的术后镇痛作用明显,可维持血流动力学稳定,麻醉安全性高,术后对患者认知功能影响较小。

Objective To analyze the application value of peripheral nerve block anesthesia in elderly patients under- going single knee arthroplasty. Methods 90 elderly patients undergoing single knee arthroplasty admitred to the Huangpi District People＇s Hospital of Wuhan City- from April 2016 to Mar. 2018 were divided into two groups according to the type of anesthesia mode, 45 eases in each group. The control group was anesthetized by combined spinal epidural anesthesia, and the observation group by peripheral nerve block anesthesia. The anesthetic status and hemodynanlie changes in the two groups were compared. Results The time of onset and improvenlent of anesthesia in the observation group were longer than those in the control groupl （3.05 -＋ 0.10） min vs （ 1.66 -＋0.08） min, （ 16.53 -＋0.44） min vs （5.97 -＋0.76） mini （ P 〈 0.01）. In the control group,the heart rate, blood pressure and blood oxygen saturation fluctuated greatly. The heart rate, blood pressure and oxygen saturation were stable at different time points in the observation group. There were significant differences in interaction between groups and time points（ P 〈 0.01 ）. 24 hours and 72 hours after operation, the visual ana- logue scale scores in the observation group were lower than those in the control group, and mini mental state exanfination scores were higher than those in the control group（P 〈 0.01 ）. The incidence of total adverse reactions in the observation group was lower than that in the control group 12.22% （2/45） vs 15.56% （7/45） ] （ P 〈 0.05 ）. Conclusion Peripheral nerve block anesthesia was performed in elderly patients with single knee arthroplasty. The analgesic effect of this anesthe- sia scheme was obvious, hemodynamie stability- was maintained, anesthesia safety was high, and the effect on cognitive function of the patients was small.