超声引导下神经阻滞麻醉在膝关节术中的应用

Application of Ultrasound-Guided Nerve Block Anesthesia in Knee Joint Surgery

目的分析超声引导下神经阻滞麻醉在膝关节术中的应用效果,探讨有效的麻醉方法,保障手术顺利进行,并减轻患者疼痛与应激反应。方法选出本院骨科2019年7月-2020年7月诊治的84例膝关节手术患者,根据不同麻醉方法将其分为A组(42例)与B组(42例),A组应用全身麻醉,B组应用超声引导下神经阻滞麻醉,对比两组患者的血流动力学(动脉压、心率)、苏醒恢复时间(睁眼时间、握拳时间、苏醒时间、拔管时间)、应激反应(肾上腺素、去甲肾上腺素)、术后疼痛程度(VAS评分)以及麻醉效果。结果B组麻醉后30 min、术毕时、拔管时的动脉压均高于A组;B组的睁眼时间、握拳时间、苏醒时间、拔管时间均短于A组,差异有统计学意义(P<0.05);B组术后的肾上腺素、去甲肾上腺素水平均低于A组,差异有统计学意义(P<0.05);B组术后2、6、12、24 h的VAS评分均低于A组,差异有统计学意义(P<0.05);B组的优良率高于A组,差异有统计学意义(P<0.05);B组麻醉效果的优良率与A组相近,差异无统计学意义(P>0.05)。结论超声引导下神经阻滞麻醉在膝关节术中的应用效果理想,对血流动力学的影响较小,患者术后苏醒恢复时间短,应激反应与疼痛轻微,麻醉效果的优良率高,值得推行。

Objective To analyze the effect of ultrasound-guided nerve block anesthesia in knee joint surgery,to explore effective methods of anesthesia,to ensure the smooth progress of the operation,and to reduce the pain and stress response of patients.Methods A total of 84 knee surgery patients diagnosed and treated in our orthopedics department from July 2019 to July 2020 were selected and divided into group A(42 cases)and group B(42 cases)according to different anesthesia methods,and group A was applied General anesthesia,ultrasound-guided nerve block anesthesia was used in group B to compare the hemodynamics(arterial pressure,heart rate),recovery time(eye-opening time,fist-making time,wake-up time,extubation time)of the two groups of patients Stimulus(epinephrine,norepinephrine),postoperative pain(VAS score),and anesthesia effect.Results The arterial pressure in group B was higher than that in group a 30 min after anesthesia,at the end of operation and at the time of extubation;The eye opening time,fist clenching time,awakening time and extubation time in group B were shorter than those in group A(P<0.05);The levels of epinephrine and norepinephrine in group B were lower than those in group A(P<0.05);The VAS scores of group B at 2,6,12 and 24 hours after operation were lower than those of group A(P<0.05);The excellent and good rate of group B was higher than that of group A(P<0.05);The excellent and good rate of anesthesia effect in group B was similar to that in group A,and the difference was not statistically significant(P>0.05).Conclusion The effect of ultrasound-guided nerve block anesthesia in knee joint surgery is ideal,with little impact on hemodynamics,short recovery time after surgery,mild stress response and pain,and high anesthetic effect rate.It is worth implementing.