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高龄患者单侧髋部手术术后恢复的不同。方法:选择择期行髋部手术的老年患者80例,随机分为下肢神经阻滞复合喉罩全身麻醉组(NB)组(n=40)与常规气管插管全麻组(GA)组(n=40)。NB组先行咪达唑仑、芬太尼作基础镇静镇痛,而后行腰丛-坐骨神经阻滞(0.4%罗哌卡因35 ml和1.0%利多卡因15 ml),再由静脉诱导置入喉罩七氟烷维持保留自主呼吸,GA组采用快诱导气管插管,控制呼吸,瑞芬太尼、七氟烷维持麻醉。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)、拔除喉罩或气管插管即刻(T3)、术后6 h(T4)、术后12 h(T5)、术后24 h(T6)、术后48 h(T7)时的MAP、HR、Sp O_2,术后6、12、24、48 h VAS评分,术后6、12、24、48 h简易智力状况检查法评分(MMSE)。术后12、24、48 h行床旁胸片及心电图检查。记录与麻醉相关的不良反应(恶心呕吐、皮肤瘙痒、咽喉疼痛、肺部并发症、心血管事件)。结果:MAP在T1、T3、T4、T5、T6期GA组均高于NB组(P<0.05)。GA组在T1、T3、T4、T5、T6期MAP和HR均高于T0(P<0.05)。Sp O_2在T4、T5、T6期NB组均高于GA组(P<0.05)。MMSE评分的降低在T4期GA组高于NB组(P<0.05),而在T5、T6、T7期两组差异无统计学意义(P>0.05)。T4、T5、T6 VAS评分NB组低于GA组(P<0.05),但T7时VAS评分两组间差异无统计学意义(P>0.05)。NB组术后恶心呕吐发生率低于GA组(P<0.05)。GA组发生4例肺不张,3例肺部感染,4例高血压,2例出现室性心律失常,1例房颤,1例出现异常Q波,1例低血压并Ⅱ导联T波倒置,NB组无术后肺部并发症,1例低血压事件,发生率低于GA组(P<0.05)。结论:下肢神经阻滞复合喉罩保留自主呼吸全身麻醉用于高龄患者单侧髋部手术能减轻术后疼痛,改善患者术后恢复情况。
Objective：To evaluate the differences of postoperative recovery of lower extremity nerve block combined with laryngeal mask general anesthesia and conventional anesthesia for elderly patients undergoing unilateral hip surgery.Method：Eighty elderly patients undergoing elective unilateral hip surgery were randomly divided into group NB and GA.In group NB,Midazolam and Fentanyl were used for basic sedation analgesia,and lower extremity nerve block were performed.After venous induction,placing the laryngeal mask airway,keeping self-breathing with Sevoflurane anesthesia.In group GA,conventional general anesthesia with tracheal intubation,controlled breathing with Remifentanil and Sevoflurane.The changes of MAP,HR and Sp O2 were recorded before anesthesia（T0）,at the time of tracheal intubation or LMA insertion（T1）,cutting skin（T2）,extubation or LMA removal（T3）,6 h after operation（T4）,12 h after operation（T5）,24 h after operation（T6）,48 h after operation（T7）.The visual analogue scale（VAS） were recorded at 6 h,12 h,24 h,48 h after operation.The mini-mental state examination was used to determine cognitive function of patients at the time of T4,T5,T6,T7.The complications such as postoperative nausea and vomiting,pruritus,throat pain,respiratory complication,cardiovascular complication were recorded.Result：At the time of T1,T3,T4,T5,T6,MAP in group GA were higher than those in group NB（P〈0.05）,at the time of T1,T3,T4,T5,T6,MAP and HR in group GA were higher than those in T0（P〈0.05）,at the time of T4,T5,T6,Sp O2 in group NB were higher than those in group GA（P〈0.05）,at the time of T4,the MMSE in group GA were lower than those in group NB（P〈0.05）,but at the time of T5,T6,T7 the two groups showed no significant difference,at the time of T4,T5,T6,the two groups showed significant difference in VAS（P〈0.05）,but at the time of T7 the two groups showed no significant difference（P〈0.05）.The complication of postoperative nausea and vomiting in the NB group
作者
刘远铭
黄天堃
LIU Yuanming;HUANG Tiankun(The Second Hospital of Longyan,Longyan 364000,China)
出处
《中外医学研究》
2018年第26期4-7,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
术后恢复
下肢神经阻滞
喉罩
高龄患者
髋部手术
Postoperative recovery
Lower extremity nerve block
LMP
Elderly patient
Hip surgery’
