超声引导下神经阻滞复合全身麻醉应用于老年全膝关节置换术中的效果观察

Effect Observation of Ultrasound-Guided Nerve Block and General Anesthesia in Elderly Total Knee Arthroplasty

目的:探讨超声引导下神经阻滞复合全身麻醉应用于老年全膝关节置换术(TKA)中的效果。方法:选取2020年1月—2021年7月于湖北省咸宁市咸安区中医医院行TKA的80例老年患者作为研究对象,采用随机数字表法分为对照组与观察组,各40例。对照组实施静吸联合全身麻醉,观察组实施超声引导下神经阻滞复合全身麻醉,比较两组麻醉效果。结果:观察组住院、拔管、苏醒时间均短于对照组,差异有统计学意义(P<0.001);两组麻醉时间比较,差异无统计学意义(P>0.05)。麻醉前,两组平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);插管、拔管时,两组MAP、HR均高于麻醉前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组拔管后30min、2h、4 h、8 h的疼痛评分均低于对照组,满意度评分高于对照组,差异有统计学意义(P<0.001)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下神经阻滞复合全身麻醉应用于老年TKA中,可以更有效地稳定血流动力学,减轻患者术后疼痛,提高麻醉效果及满意度,缩短住院时间,安全性较高。

Objective:To explore the effect of ultrasound-guided nerve block combined with general anesthesia in elderly total knee arthroplasty(TKA).Methods:A total of 80 elderly patients who underwent TKA in Xian'an District Hospital of Traditional Chinese Medicine of Xianning City of Hubei Province from January 2020 to July 2021 were selected as the study subjects.They were divided into control group and observation group according to random number table method,with 40 cases in each group.The control group implemented intravenous inhalation combined with general anesthesia and the observation group implemented ultrasound-guided nerve block combined with general anesthesia.The anesthesia effect in two groups was compared.Results:The hospitalization,extubation and awakening time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.001).There was no significant difference in the time of anesthesia between the two groups(P>0.05).Before anesthesia,there was no significant difference in mean arterial pressure(MAP)and heart rate(HR)between the two groups(P>0.05).At intubation and extubation,MAP and HR in two groups were higher than those before anesthesia,but the observation group was lower than the control group,and the difference was statistically significant(P<0.05).The pain scores at 30 min,2 h,4 h and 8 h after extubation in the observation group were lower than those in the control group,and the satisfaction scores in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.001).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided nerve block combined with general anesthesia in elderly TKA can more effectively stabilize the hemodynamics,relieve postoperative pain,improve the anesthetic effect and satisfaction,shorten the hospitalization time and have higher safety.