摘要
目的探讨超声引导下神经阻滞复合全身麻醉对老年全膝关节置换术患者镇痛效果及血流动力学的影响。方法选取2017年1月—2018年12月该院进行全膝关节置换手术的老年患者102例作为研究对象,随机数字表法分为观察组51例(超声引导下神经阻滞复合全身麻醉)和对照组51例(行静吸全身麻醉)。观察二组麻醉效果、患者麻醉前(T0)、插管时(T1)以及拔管时(T3)的心率(HR)和平均动脉压(MAP)变化、术后镇痛效果以及不良反应。结果二组手术麻醉时间差异无统计学意义(P>0.05);与对照组比较,观察组的苏醒时间、拔管时间以及住院时间明显缩短,差异均有统计学意义(t=8.535、9.968和13.719,均P<0.05)。手术中二组的血流动力学变化,T0时二组的HR和MAP差异均无统计学意义(均P>0.05),T1和T3时观察组的HR和MAP均低于对照组,差异均有统计学意义(均P<0.05);二组患者术后6h、12h、24h和48h的VAS均低于对照组,差异均有统计学意义(均P<0.05)。对照组患者中4例出现恶心、2例出现呼吸抑制、2例出现术后认知功能障碍;观察组患者中3例出现恶心、1例出现呼吸抑制;观察组不良反应发生率为5.88%,对照组为15.69%,但二组差异无统计学意义(χ2=1.286,P>0.05)。结论超声引导下神经阻滞复合全身麻醉老年全膝关节置换术患者的手术完成效果更佳、血流动力学平稳、术后镇痛效果好。
Objective To investigate the effect of ultrasound-guided nerve block combined with general anesthesia on the analgesic effect and hemodynamics of elderly patients with total knee arthroplasty.Methods one hundred and two elderly patients who underwent total knee arthroplasty in Baoji Traditional Chinese Medicine Hospital from January 2017 to December 2018 were enrolled in the study.51 patients in the observation group(ultrasound-guided nerve block combined with general anesthesia) and 51 patients in the control group(surgical general anesthesia).The effects of anesthesia,pre-anesthesia(T0),intubation(T1),and cupping(T3) heart rate(HR) and mean arterial pressure(MAP),postoperative analgesia,and adverse events were observed.Results The difference was not significant in the anesthesia time between the two groups(P>0.05).Compared with the control group,the wake-up time,extubation time and hospitalization time in the experimental group were significantly shorter,and The difference was statistically significant(t=8.535,9.968 and 13.719,P<0.05).The difference of hemodynamic changes in the two groups during surgery were not statistically significant(P>0.05).At T1 and T3,the HR and MAP of the observation group were lower than those of the control group.The difference between the two groups was not statistically significant(P>0.05).The VAS at 6 h,12 h,24 h and 48 h after operation were lower than those in the control group(P<0.05).In the control group,4 patients developed nausea,2 patients developed respiratory depression and 2 patients developed postoperative cognitive dysfunction.In the observation group,3 patients developed nausea,1 patient developed respiratory depression.The adverse reaction rate of the observation group(5.88%) was significantly lower than that of the control group(15.69%).However,the difference between the two groups was not statistically significant(χ~2=1.286,P>0.05).Conclusion Ultrasound-guided nerve block combined with generalanesthesia has better surgical outcomes,stable hemodynamics,and good postoperative analgesia.
作者
韦宁华
王波
Wei Ninghua;Wang Bo(Department of Anesthesiology,Baoji Traditional Chinese Medicine Hos pital,Baoji 721000,China)
出处
《中国煤炭工业医学杂志》
2020年第6期663-666,共4页
Chinese Journal of Coal Industry Medicine
基金
陕西省社会发展科技攻关项目(编号:2016SF-197)。
关键词
超声引导下
神经阻滞
全身麻醉
全膝关节置换术
Ultrasound guidance
Nerve block
General anesthesia
Total knee arthroplasty
