全麻复合神经阻滞麻醉对老年膝关节置换术患者术后康复的影响

Effect of General Anesthesia with Compound Nerve Block Anesthesia on Postoperative Rehabilitation of Elderly Patients Undergoing Knee Arthroplasty

目的 探讨全麻复合神经阻滞麻醉对老年膝关节置换术患者术后康复的影响。方法 采用方便抽样的方法选取2020年1月—2021年1月临清市人民医院收治的86例老年膝关节置换术患者为研究对象,采用随机数表法分为两组,每组43例。对照组患者实施喉罩全麻,观察组患者在此基础上采用腰丛-坐骨神经阻滞。比较两组患者麻醉即刻、切皮时、假体植入时、术毕时的心率、平均动脉压以及手术时间、术中全麻药物用量、患者术后(6、12、24、48 h)疼痛程度评分、麻醉药物不良反应发生率。结果 观察组患者切皮时、假体植入时、术毕时的心率、平均动脉压水平低于对照组患者,术中麻醉维持用药量低于对照组,差异有统计学意义(P<0.05)。观察组术后6、12、24、48 h视觉模拟评分低于对照组,差异有统计学意义(P<0.05)。观察组呼吸抑制等不良反应发生率为4.65%,显著低于对照组,差异有统计学意义(χ^(2)=4.074,P<0.05)。结论 全麻复合腰丛-坐骨神经阻滞麻醉能够减少对老年膝关节置换术患者血流动力学的影响,可以提高围术期镇痛效果,安全性高。

Objective To investigate the effect of general anesthesia with compound nerve block anesthesia on the postoperative rehabilitation of elderly patients with knee arthroplasty.Methods A total of 86 elderly knee replacement patients admitted to Linqing People's Hospital from January 2020 to January 2021 were selected as the research objects by convenient sampling method,and divided into two groups by random number table method,with 43 cases in each group.The control group received laryngeal mask anesthesia,and the observation group received lumbar plexussciatic nerve block on this basis.The heart rate,mean arterial pressure immediately after anesthesia,at the time of skin resection,at the time of prosthesis implantation,and after surgery,operation time,intraoperative dosage of general anesthesia,postoperative pain score(6 h,12 h,24 h,48 h),and incidence of adverse reactions to anesthesia were compared between the two groups.Results The heart rate and mean arterial pressure of observation group were lower than those of control group at the same time point during skin resection,prosthesis implantation and after surgery,and the amount of intraoperative anesthetic maintenance drug was lower than that of control group,and the difference was statistically significant(P<0.05).The visual analog scores of the observation group at 6 h,12 h,24 h and 48 h after surgery were lower than those of the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions such as respiratory depression in the observation group was 4.65%,significantly lower than the control group,the difference was statistically significant(χ^(2)=4.074,P<0.05).Conclusion General anesthesia combined with lumbar plexus-sciatic nerve block anesthesia can reduce the impact on the hemodynamics of elderly patients undergoing knee replacement,improve the perioperative analgesic effect and high safety.