神经阻滞复合全麻在膝关节置换术中的应用

Application of Nerve Block Combined with General Anesthesia in Knee Replacement

目的:分析神经阻滞复合全麻在膝关节置换术中的应用效果。方法:选择2021年1月—2024年3月萍乡矿业集团有限责任公司总医院收治的60例择期行膝关节置换术的患者,采用随机数字表法分为两组,各30例。对照组接受全麻,观察组接受神经阻滞复合全麻,比较两组术中麻醉药物使用量、血流动力学指标、术后恢复质量及不良反应发生情况。结果:观察组丙泊酚、瑞芬太尼用量均少于对照组,差异均有统计学意义(P<0.05)。麻醉前(T_(0))~手术结束时(T_(4)),两组心率(HR)、平均脉动圧(MAP)比较,差异均无统计学意义(P>0.05);麻醉诱导后即刻(T_(1))~手术结束时(T_(3)),对照组HR、MAP均低于T_(0),差异均有统计学意义(P<0.05)。两组HR时间效应比较,差异有统计学意义(F_(时间)=2.792,P_(时间)=0.027);两组MAP_(时间)效应比较,差异有统计学意义(F_(时间)=5.626,P_(时间)<0.001)。观察组术后清醒时间、首次下床活动时间均早于对照组,视觉模拟评分法(VAS)评分低于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:与全麻相比,膝关节置换术中接受神经阻滞复合全麻能有效减少术中麻醉药物的使用量,保证术中血流循环稳定,缩短患者术后清醒时间和下床活动时间,具有良好的镇痛作用。

Objective:To analyze the application effect of nerve block combined with general anesthesia in knee replacement.Method:A total of 60 patients who underwent elective knee replacement in General Hospital of Pingxiang Mining Group Co.from January 2021 to March 2024 were selected and divided into two groups by random number table method,with 30 patients in each group.The control group received general anesthesia,and the observation group received nerve block combined general anesthesia.The amount of used anesthetic drugs,hemodynamic indexes,postoperative recovery quality and the occurrence of adverse reactions were compared between the two groups.Result:The dosages of Propofol and Remifentanil in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Before anesthesia(T_(0))to the end of surgery(T_(4)),there were no significant differences in heart rate(HR)and mean arterial pressure(MAP)between the two groups(P>0.05).Immediately after induction of anesthesia(T_(1))to the end of surgery(T_(3)),HR and MAP in control group were lower than those T_(0),the differences were statistically significant(P<0.05).The time effect of HR between the two groups was statistically significant(F_(time)=2.792,P_(time)=0.027).The time effect of MAP between the two groups was statistically significant(F_(time)=5.626,P_(time)<0.001).The postoperative waking time and the first time of getting out of bed in the observation group were earlier than those in the control group,and the visual analogue scale(VAS)score was lower than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Compared with general anesthesia,nerve block combined with general anesthesia during knee replacement can effectively reduce the amount of anesthesia drugs,ensure the stability of intraoperative blood circulation,shorten the postoperative waking time and the time of getting out of bed,and have a good analgesic effect.