超声引导下外周神经阻滞麻醉联合喉罩全身麻醉对老年全膝关节置换的影响研究

Effects of Ultrasound-Guided Peripheral Nerve Block Anesthesia Combined with Laryngeal Mask General Anesthesia in Elderly Total Knee Arthroplasty

目的:探讨老年患者行全膝关节置换术(TKA)给予超声引导下外周神经阻滞麻醉联合喉罩全身麻醉的镇静镇痛效果及对应激指标的影响。方法:选取2021年6月-2022年12月贵州航天医院收治的老年TKA患者60例,根据患者自愿选择麻醉方法分为联合组与对照组,各30例。对照组给予气管插管全身麻醉,联合组给予超声引导下外周神经阻滞麻醉联合喉罩全身麻醉。比较两组镇静镇痛效果,观察应激指标[去甲肾上腺素(NE)、皮质醇(Cor)],炎性因子[C反应蛋白(CRP)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平。结果:联合组Ramasy镇静评分、疼痛评分均低于对照组,两组差异有统计学意义(P<0.05)。两组麻醉后15 min的NE、Cor水平与麻醉前比较均有明显提高,差异有统计学意义(P<0.05);联合组麻醉后15 min的NE、Cor水平明显低于对照组,差异有统计学意义(P<0.05)。与麻醉前比较,两组麻醉后24 h的CRP、IL-1β、IL-6、TNF-α水平均有明显提高,差异有统计学意义(P<0.05);联合组麻醉后24 h的CRP、IL-1β、IL-6、TNF-α水平均明显低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下外周神经阻滞麻醉联合喉罩全身麻醉用于老年TKA患者能明显提高镇静镇痛效果,减轻应激反应,改善炎性因子水平。

Objective:To investigate the effects of ultrasound-guided peripheral nerve block anesthesia combined with laryngeal mask general anesthesia on sedation and analgesia and stress indicators in elderly patients undergoing total knee arthroplasty(TKA).Methods:A total of 60 elderly patients with TKA who were admitted to Guizhou Aerospace Hospital from June 2021 to December 2022 were selected.According to the patients'voluntary selection,they were divided into the combination group and the control group,with 30 cases in each group.The control group was given tracheal cannula general anesthesia,and the combination group was given ultrasound-guided peripheral nerve block anesthesia combined with laryngeal mask general anesthesia.The sedative and analgesic effects in two groups were compared.The stress indicators[norepinephrine(NE),cortisol(Cor)]and levels of inflammatory factors[C-reactive protein(CRP),interleukin 1β(IL-1β),interleukin 6(IL-6),tumor necrosis factor-α(TNF-α)]were observed.Results:The Ramasy sedation score and pain score in combined group were lower than those in control group,and the difference between the two groups was statistically significant(P<0.05).The NE and Cor levels at 15 minutes after anesthesia in the two groups were significantly higher than those before anesthesia and the difference was statistically significant(P<0.05).The NE and Cor levels at 15 minutes after anesthesia in the combination group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).Compared with before anesthesia,the CRP,IL-1β,IL-6 and TNF-αlevels in two groups were significantly increased at 24 hours after anesthesia,with statistically significant differences(P<0.05).The levels of CRP,IL-1β,IL-6 and TNF-αin the combination group were significantly lower than those in the control group at 24 hours after anesthesia,and the difference was statistically significant(P<0.05).Conclusion:Ultrasound-guided peripheral nerve block anesthesia combined with laryngeal mask general anesthesia for TKA in elderly patients can significantly improve the sedative and analgesic effect,alleviate the stress response,and improve the level of inflammatory factors.