摘要
目的:探讨连续股神经-坐骨神经阻滞(CF-SNB)复合全身麻醉在全膝关节置换术(TKA)中的应用效果。方法:选取2016年8月至2018年8月在湖南省株洲市中心医院行TKA的86例患者,按随机数字表法分为研究组和对照组,每组43例。研究组和对照组分别在CF-SNB和连续股神经阻滞(CFNB)复合全身麻醉下进行TKA治疗。比较两组麻醉前(T0)、手术开始即刻(T1)、扩髓时(T2)、固定时(T3)、术后即刻(T4)平均动脉血压(MAP)和心率(HR),麻醉操作时间、手术时间、芬太尼、异丙酚累积用量,术前及术后1 d、3 d疼痛视觉模拟评分(VAS),麻醉期间不良反应发生率。结果:与T0时间点比较,两组T1~T3时间点MAP、T1~T2时间点HR均显著下降(P<0.05);与T1时间点比较,两组T2~T4时间点MAP和HR均显著升高(P<0.05);与T2时间点比较,两组T4时间点MAP、T3~T4时间点HR均显著升高(P<0.05);与T3时间点比较,两组T4时间点MAP、HR均显著升高(P<0.05)。研究组芬太尼及异丙酚累积用量少于对照组(P<0.05)。术后1 d、3 d,研究组静息和运动VAS评分均低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:CF-SNB复合全身麻醉有助于维持TKA中血流动力学稳定、减少麻醉用药量、缓解术后疼痛,安全可靠。
Objective:To investigate the effect of continuous femoral nerve-sciatic nerve block(CF-SNB)combined with general anesthesia in knee arthroplasty(TKA).Methods:A total of 86 patients who underwent TKA in our hospital from August 2016 to August 2018 were selected,and randomly divided into a study group and a control group,with 43 cases in each group.The patients in the control group received continuous femoral nerve block(CFNB)combined with general anesthesia,while those in the study group received CF-SNB combined with general anesthesia.Before anesthesia(T0),at the beginning of operation(T1),at reaming(T2),at fixation(T3),and immediately after operation(T4),the mean arterial blood pressure(MAP)and heart rate(HR)were recorded.The anesthesia time,operation time,cumulative dosage of fentanyl and propofol,and the visual analogue scale(VAS)score before and after 1 and 3 days of operation as well as the incidence of adverse reactions during anesthesia were compared.Results:Compared with T0,MAP at T1 to T3 and HR at T1 to T2 decreased significantly in both groups(P<0.05).Compared with T1,the MAP and HR of the two groups increased significantly at T2 to T4(P<0.05).Compared with T2,MAP at T4 and HR at T3 to T4 in both groups were significantly elevated(P<0.05).Compared with T3,MAP and HR of the two groups were significantly increased at T4(P<0.05).The cumulative dosages of fentanyl and propofol in the study group were lower than those in the control group(P<0.05).The VAS scores of rest and exercise in the study group after 1 and 3 days of operation were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:CF-SNB combined with general anesthesia was safe and effective for maintaining hemodynamic stability during TKA,reducing the amount of anesthetic drugs,and relieving pain after operation.
作者
岑艳芳
毛鑫城
Cen Yanfang;Mao Xincheng(Department of Anesthesiology,Zhuzhou Central Hospital,Zhuzhou 412000,China)
出处
《广西医科大学学报》
CAS
2020年第1期93-97,共5页
Journal of Guangxi Medical University
