超声引导下神经阻滞联合喉罩全麻对老年下肢骨折手术患者术后不良反应、血流动力学及苏醒质量的影响分析

Analysis of impact of ultrasound-guided nerve block combined with laryngeal mask general anesthesia on postoperative adverse reactions,hemodynamics and recovery quality in elderly patients undergoing lower limb fracture surgery

目的 研究超声引导下神经阻滞联合喉罩全身麻醉(全麻)对老年下肢骨折手术患者术后不良反应、血流动力学及苏醒质量的影响。方法 76例老年下肢骨折手术患者,根据麻醉方法的差异分为对照组与观察组,每组38例。对照组患者实施单纯喉罩全麻,观察组患者接受超声引导下神经阻滞联合喉罩全麻。对比两组患者麻醉前(T0)、插喉罩(T1)、切皮时(T2)、拔喉罩时(T3)的血流动力学[心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血氧饱和度(SpO2)]水平,疼痛数字评分法(NRS)评分、Ramsay镇静评分、简易智力状态检查量表(MMSE)评分,苏醒质量(苏醒时间、喉罩拔除时间、麻醉复苏室滞留时间),术后不良反应发生情况。结果 T0时,两组HR、RR、MAP、SpO2对比无显著差异(P>0.05);T1时,观察组RR(21.16±1.83)次/min比对照组的(24.64±2.05)次/min低,差异明显(P<0.05),但HR、MAP、SpO2对比无显著差异(P>0.05);T2时,观察组的HR(72.18±7.65)次/min、RR(22.30±2.10)次/min、MAP(78.82±11.23)mm Hg(1 mm Hg=0.133 kPa)均比对照组的(96.57±8.93)次/min、(26.53±3.14)次/min、(104.74±10.39)mm Hg低, SpO2(98.45±1.26)%则比对照组的(97.65±1.32)%高,差异明显(P<0.05);T3时,观察组HR(88.25±8.76)次/min、RR(18.79±1.63)次/min、MAP(93.16±10.87)mm Hg均比对照组的(111.66±12.34)次/min、(22.50±2.41)次/min、(111.83±11.53)mm Hg低,差异明显(P<0.05),但SpO2组间对比无显著差异(P>0.05)。两组拔管前10 min的NRS评分、MMSE评分均低于麻醉给药前, Ramsay镇静评分均高于麻醉给药前,差异明显(P<0.05);与对照组相比,观察组拔管前10 min的NRS评分更低,Ramsay镇静评分、MMSE评分更高,差异明显(P<0.05)。观察组的苏醒时间(5.09±1.01)min、喉罩拔除时间(10.36±2.20)min、麻醉复苏室滞留时间(40.75±6.52)min短于对照组的(6.86±1.33)、(20.94±3.72)、(51.43±10.16)min,差异明显(P<0.05)。与对照组(21.05%)相比,观察组的术后不良反应发生率(2.63%)更低,差异明显(P<0.05)。结论 对老年下肢骨折手术患者实施超声引导下神经阻滞联合喉罩全麻能够减小对血流动力学、认知功能的影响,发挥良好的镇静镇痛效果,可提升苏醒质量以及安全性。

Objective To study the impact of ultrasound-guided nerve block combined with laryngeal mask general anesthesia on postoperative adverse reactions,hemodynamics and recovery quality in elderly patients undergoing lower limb fracture surgery.Methods 76 elderly patients with lower limb fractures surgery were included.According to the differences in anesthesia methods,patients were divided into a control group and an observation group,each with 38 cases.The control group received simple laryngeal mask general anesthesia,and the observation group received ultrasound-guided nerve block combined with laryngeal mask general anesthesia.Comparison was made on hemodynamics[heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO2)]levels before anesthesia(T0),laryngeal mask insertion(T1),skin resection(T2),and laryngeal mask removal(T3),numerical rating scale(NRS)score,Ramsay sedation score,mini-mental state examination(MMSE)score,recovery quality(awakening time,laryngeal mask removal time,and anesthesia recovery room retention time),postoperative adverse reactions between the two groups.Results At T0,there was no significant difference in HR,RR,MAP and SpO2 between the two groups(P>0.05).At T1,the observation group had significantly lower RR of(21.16±1.83)times/min than(24.64±2.05)times/min in the control group(P<0.05),but there were no significant differences in HR,MAP and SpO2(P>0.05).At T2,the observation group had HR of(72.18±7.65)beats/min,RR of(22.30±2.10)times/min,MAP of(78.82±11.23)mm Hg(1 mm Hg=0.133 kPa),which were lower than(96.57±8.93)beats/min,(26.53±3.14)times/min and(104.74±10.39)mm Hg in the control group;the observation group had higher SpO2 of(98.45±1.26)%than(97.65±1.32)%in the control group;the difference was significant(P<0.05).At T3,the observation group had HR of(88.25±8.76)beats/min,RR of(18.79±1.63)times/min,MAP of(93.16±10.87)mm Hg,which were significantly lower than(111.66±12.34)beats/min,(22.50±2.41)times/min and(111.83±11.53)mm Hg in the control group(P<0.05),but there was no significant difference in SpO2 groups(P>0.05).10 min before extubation,NRS score and MMSE score in both groups were lower than those before anesthesia,while the Ramsay sedation score were higher than that before anesthesia.The differences were significant(P<0.05).Compared with the control group,the observation group had lower NRS score,higher Ramsay sedation score and MMSE score 10 min before extubation,and the difference was significant(P<0.05).The awakening time in the observation group was(5.09±1.01)min,the laryngeal mask removal time was(10.36±2.20)min,and the anesthesia recovery room retention time was(40.75±6.52)min,which were shorter than(6.86±1.33),(20.94±3.72),and(51.43±10.16)min in the control group,and the difference was significant(P<0.05).Compared with the control group(21.05%),the incidence of postoperative adverse reactions was lower in the observation group(2.63%),and the difference was significant(P<0.05).Conclusion Ultrasound-guided nerve block combined with laryngeal mask general anesthesia can reduce the impact on hemodynamics and cognitive function in elderly patients undergoing lower limb fracture surgery,exert good sedative and analgesic effects,and improve the recovery quality and safety.