超声引导下股神经-腘窝坐骨神经阻滞麻醉在老年膝骨关节炎手术患者中的应用效果

Application effects of ultrasound-guided femoral nerve-popliteal sciatic nerve block anesthesia in elderly patients with knee osteoarthritis surgeries

目的:观察超声引导下股神经-腘窝坐骨神经阻滞麻醉在老年膝骨关节炎手术患者中的应用效果。方法:选取2019年9月至2020年6月该院收治的108例行手术治疗的老年膝骨关节炎患者进行前瞻性研究,按随机数字表法将其分为观察组与对照组各54例。对照组采用超声引导下腰丛-坐骨神经麻醉,观察组采用超声引导下股神经-腘窝坐骨神经麻醉,比较两组麻醉效果,运动阻滞、感觉阻滞起效时间和持续时间,不同时间[麻醉前(T_(0))及麻醉后15 min(T_(1))、30 min(T_(2))、60 min(T_(3))]血流动力学指标(心率、平均动脉压)水平、术后疼痛程度[视觉模拟评分法(VAS)]评分,以及不良反应发生率。结果:观察组麻醉优良率为98.05%(53/54),高于对照组的85.19%(46/54),差异有统计学意义(P<0.05);观察组感觉阻滞、运动阻滞起效时间均短于对照组,感觉阻滞持续时间长于对照组,运动阻滞持续时间短于对照组,差异均有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,两组心率均低于T_(0)时,但组间比较,差异无统计学意义(P>0.05);T_(1)时,观察组平均动脉压低于对照组,但与T_(0)时比较,差异无统计学意义(P>0.05);T_(2)、T_(3)时,两组平均动脉压均高于T_(0)时,但观察组低于对照组,差异有统计学意义(P<0.05);术后10、20 h,观察组VAS评分低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为1.85%(1/54),低于对照组的14.81%(8/54),差异有统计学意义(P<0.05)。结论:超声引导下股神经-腘窝坐骨神经阻滞麻醉应用于老年膝骨性关节手术患者可提高麻醉优良率,缩短运动阻滞起效时间,延长感觉阻滞持续时间,以及降低T_(2)、T_(3)时平均动脉压水平和并发症发生率,其效果优于腰丛-坐骨神经麻醉。

Objective:To observe application effects of ultrasound-guided femoral nerve-popliteal sciatic nerve block anesthesia in elderly patients with knee osteoarthritis surgeries.Methods:A prospective study was conducted on 108 elderly patients with knee osteoarthritis who were treated in this hospital from September 2019 to June 2020.They were divided into observation group and control group according to the random number table method,54 cases in each group.The control group was given lumbar plexus nerve-sciatic nerve anesthesia,while the observation group was given ultrasound-guided femoral nerve-popliteal sciatic nerve anesthesia.The anesthesia effect,the onset time and duration of motor block and sensory block,the hemodynamic levels(heart rate,mean arterial pressure)at different times[before anesthesia(T_(0))and 15(T_(1)),30(T_(2)),and 60 minutes(T_(3))after anesthesia],the postoperative pain level[visual analog scale(VAS)]score,and the incidence of adverse reactions were compared between the two groups.Results:The excellent and good rate of anesthesia in the observation group was 98.05%(53/54),which was higher than 85.19%(46/54)in the control group,and the difference was statistically significant(P<0.05).The onset time of sensory block and motor block in the observation group were shorter than those in the control group;the duration of sensory block was longer than that of the control group;the duration of motor block was shorter than that of the control group;and the differences were statistically significant(P<0.05).At T_(1),T_(2),and T_(3),the heart rates of the two groups were lower than those at T_(0),but there was no significant difference between the two groups(P>0.05).At T_(1),the mean arterial pressure of the observation group was lower than that of the control group,but there were no significant differences compared with those at T_(0)(P>0.05).At T_(2) and T_(3),the mean arterial pressure levels in the two groups were higher than those at T_(0),but those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).10 and 20 hours after the surgery,the VAS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 1.85%(1/54),which was lower than 14.81%(8/54)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Ultrasoundguided femoral nerve-popliteal sciatic nerve block anesthesia applied to the elderly patients with knee osseous joint surgeries can improve the excellent and good rate of anesthesia,shorten the onset time of motor block,prolong the duration of sensory block,and reduce the mean arterial pressure levels at T_(2) and T_(3) and the incidence of complications.Moreover,it is superior to lumbar plexus-sciatic nerve anesthesia.