摘要
目的观察术后单次股神经阻滞复合静脉镇痛对股骨干下段骨折患者术后镇痛的影响。方法患者60例,择期在喉罩麻醉下行股骨干下段骨折切开复位内固定术。采用随机数字表法分为AB两组,A组:静脉镇痛;B组:术后超声引导下单次股神经阻滞+静脉镇痛。两组均行喉罩麻醉,A组以舒芬太尼2μg/kg+托烷司琼0.15mg/kg配成100ml入电子镇痛泵。B组在手术结束后、麻醉未醒前行超声引导下股神经阻滞,单次注入0.3%罗哌卡因30ml,镇痛泵配方中舒芬太尼改为1.5μg/kg。观察术后1h(T_0)、手术结束后6h(T_1)、手术结束后12h(T_2)、手术结束后24h(T_3)、手术结束后48h(T_4)患者心率(HR)、血氧饱和度(Spo2)、收缩压(SBP)、舒张压(DBP)的变化;采用视觉模拟评分(VAS)和Ramsay镇静评分测定两组患者各时间节点疼痛程度的变化;记录术后48h内镇痛泵按压次数、恶心、呕吐、皮肤瘙痒、头晕、呼吸抑制、嗜睡等不良反应的发生情况;比较两组患者镇痛满意度及总体评价满意率。结果⑴T_0、T_1、T_2时间点:B组HR、SBP、DBP、VAS评分明显低于A组,Ramsay评分B组明显高于A组,镇痛泵按压次数及术后不良反应发生情况B组明显少于A组,差异有统计学意义(P<0.05)。两组Spo2差异不大,无统计学意义(P>0.05)。⑵T_3、T_4时间点各项指标比较,两组差异不大,无统计学意义(P>0.05)。⑶B组患者镇痛满意度及总体评价满意率明显高于A组(P<0.05)。结论术后超声引导下单次股神经阻滞复合静脉镇痛对股骨干下段骨折患者术后镇痛效果更佳,血流动力学更平稳,不良反应发生率更低。
Objective To observe the effect of single intravenous femoral nerve block combined intravenous analgesia on post- operative analgesia in patients with femoral shaft fractures. Methods Sixty patients were enrolled in the study,They underwent open reduction and internal fixation of the lower femoral shaft fracture under laryngeal masking. The random number table method was used to divide the two groups,group A： intravenous analgesia;group B：single femoral nerve block ＋ intravenous analgesia after ultrasound guidance. Laryngeal mask anesthesia was performed in both groups. In group A,lOOmg perfusion sufentanil 2μg/kg plus tropisetron 0.15mg/kg was administered into the electronic analgesic pump. In group B,ultrasound-guided femoral nerve block was performed at the end of surgery and before anesthesia was awakened. A single injection of 0.3% ropivacaine （30ml） was used. In the analgesic pump formula,sufentanil was changed to 1.5μg/kg. The heart rate （HR） was observed at 1 hour （T0） after the end of surgery, 6 hours （T1） after the end of the surgery, 12 hours （T2） after the end of the surgery,24 hours （T3） after the end of the surgery,and 48 hours after the end of the surgery（T4）. Changes in blood oxygen saturation （Spo2）,systolic blood pressure （SBP）,and diastolic blood pressure （DBP）;visual analog scale （VAS） and Ramsay sedation scores were used to determine pain changes at each time point in both groups;The number of analgesic pump compressions,nausea,vomiting,pruritus,dizziness,respiratory depression, drowsiness, and other adverse reactions occurred within hours ;the degree of satisfaction with analgesia and overall satisfaction rate were compared between the two groups. Results （1）T0,T1,and T2 time points：The HR,SBP,DBP,and VAS scores of group B were significantly lower than that of group A. The Ramsay score of group B was significantly higher than that of group A,and the number of analgesic pump presses and postoperative adverse reactions were found. B gr
作者
杨玉军
华福州
陈勇
徐国海
帅君
YANG Yujun;HUA Fuzhou;CHEN Yong(Department of Anesthesiology,Second Affiliated Hospital,Nanchang University,Nanchang 330006,China;Department of Anesthesiology,Nanchang 334 Hospital Nanchang 330006,China.)
出处
《江西医药》
CAS
2018年第8期806-809,共4页
Jiangxi Medical Journal
关键词
超声引导
股神经阻滞
喉罩麻醉
股骨干下端骨折
术后镇痛
Ultrasound guidance
Femoral nerve block
Laryngeal mask anesthesia
Fracture of the femoral shaft
Postopera-tive analgesia
