超声引导下神经阻滞联合喉罩全麻在膝关节置换术患者中的麻醉效果及对应激反应的影响

Anesthetic effect of ultrasound-guided nerve block combined with laryngeal mask general anesthesia in patients undergoing knee arthroplasty and its influence on stress response

目的分析超声引导下神经阻滞联合喉罩全麻在膝关节置换术患者中的麻醉效果及对应激反应的影响。方法按照麻醉方案不同将2020年1月至12月我院收治的96例膝关节置换术患者分为常规组(48例,喉罩全麻)和观察组(48例,超声引导下神经阻滞联合喉罩全麻)。比较两组的麻醉效果。结果手术10 min(T_(2))至术后30 min(T_(5))时,观察组的平均动脉压(MAP)、呼气末二氧化碳(ETCO_(2))及血氧饱和度(SpO_(2))均显著高于常规组(P<0.05);手术切皮时(T_(1))至T_(5)时,观察组的MAP、ETCO_(2)及SpO_(2)波动幅度小于常规组。观察组的顺阿曲库铵与阿芬太尼使用剂量均小于常规组,麻醉至苏醒时间与苏醒至离室时间均短于常规组(P<0.05)。T_(5)时,两组的前列腺素E_(2)(PGE_(2))、5-羟色胺(5-HT)、神经肽Y(NPY)、β-内啡肽(β-EP)及皮质醇(Cor)水平均升高,但观察组显著低于常规组(P<0.05)。结论超声引导下神经阻滞联合喉罩全麻用于膝关节置换术患者中可取得理想的麻醉效果,抑制围术期的应激反应,值得推广。

Objective To analyze the anesthetic effect of ultrasound-guided nerve block combined with laryngeal mask general anesthesia in patients undergoing knee arthroplasty and its influence on stress response.Methods A total of 96 patients undergoing knee arthroplasty admitted in our hospital from January to December 2020 were divided into conventional group(48 cases,laryngeal mask general anesthesia)and observation group(48 cases,ultrasound-guided nerve block combined with laryngeal mask general anesthesia)according to different anesthesia scheme.The anesthetic effects of the two groups were compared.Results From 10 min of operation(T_(2))to 30 min after operation(T_(5)),the mean arterial pressure(MAP),end-tidal carbon dioxide(ETCO_(2))and oxygen saturation(SpO_(2))in the observation group were significantly higher than those in the conventional group(P<0.05);from surgical incision(T1)to T5,the fluctuation ranges of MAP,ETCO_(2)and SpO_(2)in the observation group were smaller than those in the conventional group.The doses of cisatracurium and alfentanyl in the observation group were lower than those in the conventional group,and the time from anesthesia to awakening and the time from awakening to leaving the room were shorter than those in the conventional group(P<0.05).At T5,the levels of prostaglandin E_(2)(PGE_(2)),5-hydroxytryptamine(5-HT),neuropeptide Y(NPY),β-endorphin(β-EP)and cortisol(Cor)in the two groups increased,but those in the observation group were significantly lower than the conventional group(P<0.05).Conclusion Ultrasound-guided nerve block combined with laryngeal mask general anesthesia for patients undergoing knee arthroplasty can achieve ideal anesthetic effect and inhibit perioperative stress response,which is worthy of promotion.