喉罩全麻与超声引导股神经置管股神经阻滞在全膝关节置换术的应用

Application of Laryngeal Mask General Anesthesia Combined with Ultrasound-Guided Femoral Nerve Catheterization Femoral Nerve Block in Total Knee Arthroplasty

目的:探讨喉罩全麻与超声引导股神经置管股神经阻滞在全膝关节置换术的应用。方法:将2021年8月~2022年11月永春县医院收治的80例择期行单侧TKA手术患者随机分为两组:对照组(C组)和观察组(T组),每组40例。C组患者在喉罩全麻下完成手术治疗,术后采用患者自控静脉镇痛;T组患者采用喉罩全麻与超声引导下股神经置管股神经阻滞下完成手术治疗,术毕行连续FNB复合PCIA镇痛。对比两组患者手术切皮时(T1)、手术开始1h(T2)、2h(T3)和麻醉苏醒时(T4)、术后24h(T5)、术后48h(T6)六个时间点平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2),术中总的舒芬太尼用量、总出血量,T4~T6三个时间点VAS疼痛评分,术后首次下床活动时间、氟比洛芬酯总用量和患者总满意度评分。结果:与C组比较,T组T1~T6六个时间点MAP、HR降低,术中舒芬太尼总用量、总出血量减少,术后T4~T6三个时间点VAS疼痛评分均降低,术后首次下床活动时间减少,氟比洛芬酯总用量降低、患者总满意度评分提升,两组对比差异均有统计学意义(均P<0.05)。结论:全膝关节置换术患者采用喉罩全麻与超声引导股神经置管股神经阻滞联合应用具有良好的麻醉镇痛效果,围术期患者生命征平稳,术中对阿片类药物需求量和出血量降低,术后首次下床活动时间减少,患者满意度高。

Objective:To investigate the application of laryngeal mask airway general anesthesia and femoral nerve block(FNB)guided by ultrasound in total knee arthroplasty(TKA).Methods:From August 2021 to November 2022,80 patients with unilateral TKA admitted to Yongchun County Hospital.They were randomly divided into two groups:the control group(group C)and the observation group(group T),with 40 cases in each group.Patients in group C were treated with a laryngeal mask under general anesthesia,and patient-controlled intravenous analgesia was administered after the surgery.Patients in group T were treated with general anesthesia using a laryngeal mask,combined with ultrasound-guided femoral nerve catheterization and FNB.They also underwent continuous FNB combined with patient-controlled intravenous analgesia(PCIA)for pain management.The mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SPO2),total amount of sufentanil,and total amount of blood loss during the operation(T1),at 1 hour(T2),and at 2 hours(T3)after the start of the operation were compared between the two groups.Additionally,the six time points at anesthesia recovery(T4),24 hours(T5),and 48 hours(T6)after the operation were also compared.VAS pain scores were recorded at T4-T6 time points,including the first instance when the patient got out of bed.The total dosage of flurbiprofen axetil administered and the patients’overall satisfaction scores were also recorded.Results:In comparison to group C,group T experienced lower MAP and HR at six time points(T1-T6),reduced blood loss and total sufentanil dosage during the operation,and reduced VAS pain scores at three time points(T4-T6)following the procedure.Additionally,there was a decrease in the first ambulation time,a decrease in the total dose of Flurbiprofen Axetil,and an increase in the overall satisfaction score.There were statistically significant differences between the two groups(all P<0.05).Conclusion:Laryngeal mask general anesthesia combined with ultrasound-guided femoral nerve catheterization and FNB has a good anesthetic and analgesic effect in patients undergoing TKA.Perioperative vital signs of patients remain stable,intraoperative demand for opioids and blood loss are significantly reduced,and the time for the first postoperative activity is shortened,resulting in high patient satisfaction.