摘要
目的观察超声引导下单次髂筋膜阻滞(s-FICB)对全身麻醉下接受全膝关节置换术(TKA)的老年患者术中麻醉管理及术后早期镇痛效果的影响。方法选择首次接受单侧TKA的老年患者121例,随机分为对照组60例、s-FICB组61例。对照组接受全身麻醉,行关节腔周围浸润+术后静脉镇痛泵;s-FICB组在对照组基础上,于全麻诱导前行s-FICB(0.25%罗哌卡因30 mL)。比较两组术中全麻药物用量、机械通气时间、拔出喉罩与手术结束时间点的差值。比较两组诱导前(T1)、诱导后5 min(T2)、止血带充气后5 min(T3)和止血带放气后(T4)时的平均动脉压(MAP)、心率(HR)。比较两组苏醒时和术后6、12、24、48 h的视觉模拟评分(VAS)。记录术后改良Broomage评分和神经阻滞相关并发症情况。结果s-FICB组瑞芬太尼用量、丙泊酚用量少于对照组,机械通气时间短于对照组(P均<0.01),拔出喉罩的时间较对照组提前28.67 min(由对照组的手术结束后16.65 min提前至手术结束前12.02 min),机械通气时间较对照组缩短25.52 min。s-FICB组MAP和HR较对照组波动小。s-FICB组术后24 h内的运动VAS低于对照组(P均<0.01),两组24 h内的静息VAS和48 h的运动、静息VAS差异均无统计学意义(P均>0.05)。s-FICB组改良Broomage评分均为0,且均未发生神经阻滞相关并发症。结论s-FICB能优化老年TKA患者的全麻管理,减少全麻药用量、利于在手术结束前拔出喉罩、缩短机械通气时间、减少血流动力学波动,并能降低术后24 h内运动VAS。
Objective To evaluate the effects of ultrasound-guided single-shot fascia iliaca compartment block(s-FICB)on intraoperative general anesthesia management and early-postoperative stage analgesia in elderly patients undergoing total knee arthroplasty.Methods A total of 121 elderly patients who were to receive primary unilateral TKA were enrolled.All patients were randomly allocated to two groups:the control group(60 cases)and the s-FICB group(61 cases).Patients in the control group received general anesthesia(GA),periarticular infiltration(PAI)and patient controlled intravenous analgesia(PCIA)pump after surgery.While in the s-FICB group,patients received s-FICB before induction of GA,with 0.25%ropivacaine 30 mL.The rest anesthesia protocols were the same to the control group.Following parameters were compared between the two groups:dosage of GA anesthetics,mechanical ventilation time and the time gap between the removal of the laryngeal mask airway(LMA)and the end of surgery.Hemodynamic parameters(including mean arterial pressure,MAP,and heart rate,HR)were compared at different time spots:before induction(T 1),5 min after induction(T 2),5 min after tourniquet inflation(T 3),and after tourniquet deflation(T 4).Visual analogue scale(VAS)scores at recovery of anesthesia and 6,12,24,48 h after surgery were compared.Post-operative modified Broomage scale and other peripheral nerve block(PNB)related complications were also compared.Results Compared with the control group,the dosage of propofol and remifentanil in s-FICB group was less and the mechanical ventilation time was shorter(P<0.01).The LMA was removed 12.02 min before the end of surgery in s-FICB group,while in the control group,it was 16.65 min after the end of surgery and that,in total,led to a 28.67 min variance.The mechanical ventilation time was 25.52 min shorter in s-FICB group.The MAP and HR in s-FICB group fluctuated less.Within 24 h after surgery,VAS scores at motion in the s-FICB group were lower than the control group,P<0.01.And there were no difference in VAS scores at rest within 24 h and VAS scores at rest motion at 48 h,P>0.05.However,VAS scores at 48 h were significantly higher than that within 24 h.Modified Broomage scales in s-FICB group were zero and no complications related to PNB occurred.Conclusion s-FICB,with 0.25%ropivacaine 30 mL,can optimize the GA management in elderly TKA patients in reducing GA anesthetic dosage,reducing hemodynamic fluctuations,removing LMA before the end of surgery and shortening mechanical ventilation time.And s-FICB can reduce the VAS scores at motion within 24 h after surgery.
作者
刘晓
郭新元
李传刚
LIU Xiao;GUO Xinyuan;LI Chuangang(Department of Anesthesiology,The Second Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250033,China;Neonatal Intensive Care Unit,The Second Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250033,China)
出处
《老年医学研究》
2020年第1期4-8,共5页
Geriatrics Research
关键词
超声引导
髂筋膜阻滞
全身麻醉
全膝关节置换术
老年人
多模式镇痛
ultrasound-guided
fascia iliaca compartment block
general anesthesia
total knee arthroplasty
elderly patients
multimodal analgesia
