| 下肢神经阻滞复合喉罩全身麻醉对老年患者单膝关节置换术术后恢复的观察 |
| 投稿时间：2014-09-04 修订日期：2014-09-19 点此下载全文 |
| 引用本文：黄代强,高巍,申新.下肢神经阻滞复合喉罩全身麻醉对老年患者单膝关节置换术术后恢复的观察[J].医学研究杂志,2015,44(3):44-48 |
| DOI：
10.3969/j.issn.1673-548X.2015.03.013 |
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| 基金项目:国家自然科学基金资助项目(青年项目)(81301308);陕西省自然科学基础研究计划项目(青年项目)(2014JQ4158) |
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| 中文摘要:目的 比较下肢神经(腰丛-坐骨神经)阻滞复合喉罩全身麻醉与气管插管全身麻醉用于老年患者单膝关节置换术术后恢复的不同。方法 选择择期行单膝关节置换术的老年患者80例, 随机分为神经阻滞(NB)组(n=40)与全身麻醉(GA)组(n=40)。NB组先行腰丛-坐骨神经阻滞(0.4%罗哌卡因50ml), 随后静脉诱导置入喉罩保留自主呼吸, GA组直接静脉诱导, 插入气管导管, 控制呼吸。麻醉维持两组均采用TCI泵注。分别记录两组入室麻醉前(T0)、喉罩置入或气管插管即刻(T1)、切皮(T2)、止血带1h(T3)、松止血带5min(T4)、拔除喉罩或气管导管即刻(T5)、术后6h(T6)、术后24h(T7)时的平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2), 术后6、24、48h视觉模拟评分(VAS), 术后6、24、48h进行简易智力状况检查法(MMSE)评分以评估术后认知功能障碍发生情况。术后48h行床旁X线胸片和心电图检查。记录与麻醉相关的不良反应(苏醒时躁动、术后恶心、呕吐、咽喉疼痛、呼吸系统不良事件及心血管不良事件等)。结果 MAP在T1、T3、T5、T6时点GA组均明显高于NB组(P<0.05)。GA组在T1、T3、T5、T6时点MAP均高于T0(P<0.05)。T4期GA组低于NB组(P<0.05)。GA组HR在T1、T3、T5、T6时点均高于T0(P<0.05)。GA组和NB组T4时点HR均高于T0时点(P<0.05)。SpO2在T6、T7时点NB组均高于GA时点(P<0.05)。术后6、12hVAS NB组低于GA组(P<0.05), 但24hVAS两组比较差异无统计学意义(P>0.05)。MMSE评分降低在6、24h时发生率GA组高于NB组(P<0.05)。NB组术后恶心、呕吐及咽喉疼痛发生率低于GA组(P<0.05)。GA组有15例苏醒时发生躁动, 8例发生术后肺部感染, 5例肺不张, 3例出现室性心律失常, 1例出现异常Q波, NB组有2例苏醒时发生躁动, 1例发生术后肺部感染, 无心血管不良事件。结论 下肢神经阻滞联合喉罩保留自主呼吸全身麻醉用于老年患者单膝关节置换术能够改善患者术后恢复情况, 并可减轻术后疼痛。 |
| 中文关键词:术后恢复 下肢神经阻滞 膝关节置换术 老年患者 |
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| Observation on Postoperative Recovery of Lower Extremity Nerve Block Combined with General Anesthesia Using LMA in Elderly Patients Undergoing Single Knee Arthroplasty |
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| Abstract:Objective To evaluate the difference of general anesthesia with laryngeal mask airway(LMA) combined with lower extremity nerve block and conventional general anesthesia in elderly patients undergoing single knee arthroplasty. Methods Eighty elderly patients undergoing single knee arthroplasty were randomly divided into group GA and NB. Group GA received conventional tracheal intubation general anesthesia. Group NB received lower extremity nerve block guided by nerve stimulator and ultrasound then combined general anesthesia with laryngeal mask airway. The changes of MAP, HR and SpO2 were recorded before anesthesia(T0), at the time of tracheal intubation or LMA insertion(T1), cutting skin(T2), the tourniquet time at 60min(T3), the time of loosening tourniquet(T4) and extubation or LMA removal(T5), 6h after operation(T6) and 24h after operation(T7). The complications such as postoperative nausea and vomiting(PONV), throat pain, respiratory complication, cardiovascular complication were recorded. The visual analogue scale(VAS) were recorded at 6h, 12h and 24h. Results At the time of T1, T3, T5, T6, MAP in group GA were significantly higher than those in group NB(P<0.05); at the time of T1, T3, T5, T6, MAP in group GA were significantly higher than those in T0(P<0.05); at the time of T1, T3, T5, T6, HR in group GA were significantly higher than those in group NB(P<0.05). The incidence of PONV, throat pain, respiratory and cardiovascular complication in group GA were significantly higher than those in group NB. At 6h and 12h after operation. The two groups showed significant difference in VAS (P<0.05), then at 24h the two groups showed no significant differences. Conclusion General anesthesia(GA) with LMA combined with lower extremity nerve block could be applied to elder patients undergoing single knee arthroplasty safely and effectively. This procedure could maintain hemodynamic stability and provide good postoperative analgesia effect and less complications. |
| keywords:Postoperative recovery Lower extremity nerve block Knee arthroplasty Elderly patient |
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