摘要
目的探讨在高龄患者髋关节置换术中改良髂筋膜阻滞(fascia illiaca compartment block,FICB)联合坐骨神经阻滞的麻醉效果。方法选择2018-05至2019-12在我院行髋关节置换术的高龄患者60例,随机分为两组:全麻组(G组,n=30)和改良髂筋膜阻滞联合坐骨神经阻滞组(N组,n=30)。分别记录两组入室时(T1)、麻醉操作完成后10分钟(T2)、切皮时(T3)和手术结束时(T4)的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR);计算术中丙泊酚、舒芬太尼、瑞芬太尼和血管活性药物的使用情况;记录术中输液量、清醒时间、清醒时疼痛视觉模拟评分(visual analogue scale,VAS)评分以及术后追加镇痛药的情况。结果与T1(102.14±16.46)时相比,G组MAP在T2和T3(81.43±7.04,81.57±13.40)时明显降低(P<0.05)。与G组相比,N组术中未使用瑞芬太尼,且舒芬太尼用量(32.73±3.44)、输液量(1092.86±477.52)、血管活性药物和术后追加镇痛药的需求明显下降(P<0.05)。N组术后清醒时间(13.25±3.85)较短,清醒时的VAS评分(1.22±0.97)较低,差异有统计学意义(P<0.05)。结论高龄老年患者髋关节置换术中可以安全有效地应用改良FICB联合坐骨神经阻滞的麻醉方法。
Objective To investigate the effect of modified fascia illiaca compartment block(FICB)combined with sciatic nerve block for elderly patients receiving hip arthroplasty.Methods Patients over 70 years and older undergoing hip arthroplasty treated in our hospital were recruited and assigned into 2 groups(30 for each):general anesthesia group(group G)and modified FICB combined with sciatic nerve block group(group N).The mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia(T1),10 min after intubation or nerve block(T2),skin incision(T3)and at the end of surgery(T4).The total amount of propofol,sufentanil and remifentanil were calculated.Vasoactive drugs and infusion volume during surgery,recovery time,postoperative visual analogue scale(VAS)score,needs for postoperative analgesia were also recorded.Results At T2 and T3,MAP(81.43±7.04,81.57±13.40)in group G were significant lower than those at T1(102.14±16.46)(P<0.05).Remifentanil was not used in group N.Compared with group G,the intraoperative consumption of sufentanil(32.73±3.44),infusion volume(1092.86±477.52),requirement of vasoactive drugs and needs for postoperative analgesia were significant decreased in group N(P<0.05).Patients in group N had a shorter recovery time(13.25±3.85)and lower postoperative VAS score(1.22±0.97)(P<0.05).Conclusions Modified FICB combined with sciatic nerve block was an effective method for elderly patients undergoing arthroplasty.great significance for the improvement of the diagnosis rate of small lung nodules in high-risk groups of lung cancer and the detection of early lung cancer.Attention should be paid to long-term follow-up of high-risk groups.
作者
安丽娜
张谦
郭文治
AN Li'na;ZHANG Qian;GUO Wenzhi(Department of Anesthesiology,the Third Medical Centre,Chinese PLA General Hospital,Beijing 100039,China;Department of Anesthesiology,the Seventh Medical Centre,Chinese PLA General Hospital,Beijing 100700,China)
出处
《中华灾害救援医学》
2020年第12期672-675,共4页
Chinese Journal of Disaster Medicine
基金
武警部队院级课题(WZ2017024)。
