超声引导下股神经阻滞联合全身麻醉对高龄膝关节镜手术患者镇痛和术后谵妄的影响

Effect of ultrasound-guided femoral nerve block combined with general anesthesia on analgesia and postoperative delirium in elderly patients undergoing arthroscopic knee surgery

目的探讨超声引导下股神经阻滞(FNB)联合全身麻醉对高龄膝关节镜手术(AKS)患者的镇痛和术后谵妄的影响。方法将82例接受单侧AKS治疗的膝关节病变高龄患者随机分为FNB组与对照组,每组41例。FNB组患者采用超声引导下FNB联合全身麻醉,对照组患者采用单纯全身麻醉,两组患者术后均采用患者自控镇痛(PCIA)。比较两组麻醉诱导前(T 1)、切皮前(T 2)、手术30 min(T 3)、术毕时(T 4)和术后30 min(T 5)的血流动力学指标变化,以及围术期麻醉药物用量、苏醒时间、首次下床时间及术后谵妄发生率。结果在T 2~T 5时,FNB组患者的平均动脉压(MAP)、收缩压、舒张压均高于对照组,心率均低于对照组(均P<0.05),对照组患者的MAP、收缩压、舒张压均低于T 1时,心率均高于T 1时(均P<0.05),而FNB组患者的MAP、收缩压、舒张压及心率变化不明显。FNB组术中瑞芬太尼及丙泊酚用量、术后48 h PCIA用药量、苏醒时间、首次下床时间、术后3 d内谵妄发生率均少于、短于或低于对照组(均P<0.05)。结论高龄AKS患者采用超声引导下FNB联合全身麻醉可有效地维持术中血流动力学稳定,减轻术后疼痛,减少术中及术后麻醉药物用量,减少术后谵妄的发生,促进患者术后康复。

Objective To investigate the effect of ultrasound-guided femoral nerve block(FNB)combined with general anesthesia on analgesia and postoperative delirium in elderly patients undergoing arthroscopic knee surgery(AKS).Methods Eighty-two elderly patients with knee joint diseases treated by unilateral AKS were randomly divided into FNB group(n=41)and control group(n=41).Patients in the FNB group were treated with ultrasound-guided FNB combined with general anesthesia,patients in the control group received simple general anesthesia,and patients in both groups underwent postoperative patient-controlled intravenous analgesia(PCIA).The two groups were compared in terms of changes in hemodynamic parameters before anesthesia induction(T 1),before skin incision(T 2),30 minutes of operation(T 3),at the end of operation(T 4)and 30 minutes afteRoperation(T 5),as well as perioperative anesthetics dosage,recovery time,first ambulatory time,and incidence rate of postoperative delirium.Results During T 2 to T 5,the FNB group yielded higheRmean arterial pressure(MAP),SBP and DBP,and loweRheart rate than the control group(all P<0.05),in the control group,MAP,SBP and DBP were lower,and heart rate was higheRthan those at T 1(all P<0.05),whereas there were few significant changes in MAP,SBP,DBP and heart rate in the FNB group.The FNB group exhibited feweRintraoperative dosages of remifentanil and propanediol,less drug consumption foRPCIA 48 hours postoperatively,shorteRrecovery time and first ambulatory time,and loweRincidence rate of delirium within three days afteRoperation as compared with the control group(all P<0.05).Conclusion The use of ultrasound-guided FNB combined with general anesthesia can effectively maintain intraoperative hemodynamic stability,diminish postoperative pain,reduce intraoperative and postoperative anesthetics dosage,decrease the incidence of postoperative delirium and promote postoperative recovery in elderly AKS patients.