摘要
目的评价超声引导下髂筋膜腔隙阻滞联合喉罩下全麻用于全髋关节置换的临床效果。方法择期行髋关节置换手术患者62例,年龄55~85岁,体质量55~75 kg,ASA分级Ⅰ~Ⅲ级,采用随机数字法将其分为生理盐水组（N组）和罗哌卡因组（R组）,各31例。R组在手术开始前30 min行患侧超声引导下髂筋膜腔隙阻滞,注入0.375%罗哌卡因20 m L,N组注入同等容量的生理盐水。随后进行全麻诱导置入喉罩,术毕所有患者行自控镇痛。镇痛药物配方为：舒芬太尼100μg＋托烷司琼5 mg/100 m L,背景输注剂量2 m L/h,PCA 2m L,锁定时间20 min,连接外周静脉。当患者感觉疼痛剧烈时给予曲马多50~100 mg进行补救。记录术中阿片类镇痛药瑞芬太尼的用量;记录术后2 h（T1）,6 h（T2）、12 h（T3）、24 h（T4）及48 h（T5）静息及主动运动时视觉模拟疼痛评分（VAS）和术后24 h和48 h内曲马多的用量,记录神经阻滞操作过程中误入血管及异感情况;记录术后局麻药中毒,恶心呕吐等不良的发生情况。结果与N组相比,R组术中阿片类镇痛药用量（1.1±0.5）mg更少（P〈0.05）;R组T1~T3静态VAS评分（1.6±0.6）、（1.8±0.7）、（1.7±0.6）及T1~T4主动运动VAS评分（1.8±0.7）、（2.0±0.7）、（1.9±0.8）、（2.0±0.7）小于N组（P〈0.05）;2组T4~T5静态及T5主动运动VAS评分差异无统计学意义,曲马多用量差异无统计学意义,术后不良反应发生率差异无统计学意义。结论超声引导下髂筋膜腔隙阻滞联合喉罩下全麻用于全髋关节置换能获得良好的镇痛效果,可减少阿片类药物用量,提高神经阻滞及术后镇痛的效果。
Objective To evaluate ultrasound guided iliac fascia lacuna block under the joint laryngeal mask anesthesia used in the clinical effect of total hip replacement. Methods The patients undergoing elective hip replacement surgery in 62 cases, 55 - 85 years old, body quality 55 - 75 kg, ASA classⅠ -Ⅲ, USES the method of random Numbers to be divided into normal saline group （group N） and pp because group （R group） each group has 31 patiemts. R group of 30 min before the start of the operation line of ultrasound guided iliac fascia lacuna block, injecting 0.375% ROM pp paid 20 ml, N group of physiological saline injection equivalent capacity. Subsequent induction of general anesthesia in laryngeal mask, all patients controlled analgesia. Analgesic drug formula for： sufentanil 100 μ g ＋ tropane SiQiong 5 mg / 100 mL, background infusion dose of 2 mL/ h, PCA 2mL, locking time 20 min, connecting peripheral vein. When patients feel pain for tramadol 50 to 100 nag of remedy. Credit records of opioid fentanyl dosage; record 2 h after surgery （T 1）, 6 h （T 2）, 12 h （T 3）, 24 h （T 4） and 48 h （T 5） resting and active sports visual analog pain score （VAS） within 48 h and 24 h after surgery and the dosage oftramadol records go vascular and nerve block operation sense of vision; Record the postoperative local anesthetics poisoning, the occurrence of nausea and vomiting and other adverse situation. Results Compared with the N group, R group of opioid dosage （1.1 ± 0.5） less mg （P〈0.05）, the R group T1-T3 static VAS score and T1-T4 active sports VAS score [（1.8 ± 0.7）,（2.0 ±0.7）,（1.9 ± 0.8）,（2.0± 0.7）] is less than N group （P〈0.05）, two groups and T5 -T4 and T 5 static movement no statistically significant differences in VAS score, the dosage of tramadol no statistical differences, there was no statistically significant difference postoperative incidence of adverse reactions. Conclusion Ultrasound guided iliac fascia lacuna block under the joint laryngeal
出处
《当代医学》
2016年第4期1-3,共3页
Contemporary Medicine
基金
江西省赣州市科技局计划课题(201268)
关键词
超声引导
全髋关节置换
喉罩
Guided by ultrasound
Total hip replacement
Laryngeal mask
