摘要
目的观察布托啡诺复合罗哌卡因超声引导神经阻滞对老年患者髋关节置换术后早期恢复的影响。方法选择行全髋关节置换术患者90例,随机分为罗哌卡因组(R组)和布托啡诺复合罗哌卡因组(BR组),每组45例。B超引导下行腰丛和骶丛神经阻滞。R组患者腰丛和骶丛神经阻滞分别给予0.2%罗哌卡因30 mL和20 mL。BR组患者在0.3%罗哌卡因局麻药中加入布托啡诺20μg/kg,腰丛和骶丛神经阻滞分别给予含布托啡诺的0.3%罗哌卡因30 mL和20 mL。记录患者入手术室(T_(0))、神经阻滞后5 min(T_(1))、15 min(T_(2))、30 min(T_(3))以及术后30 min(T_(4))、60 min(T_(5))、120 min(T 6)的血压、心率和氧饱和度变化情况。观察神经阻滞起效时间、记录术中两组患者丙泊酚和芬太尼用量。术前30 min(t_(0)),术后6 h(t_(1)),12 h(t_(2)),24 h(t_(3)),48 h(t_(4)),72 h(t_(5))采用QoR-40量表对患者进行评分,同时采用VAS评分观察患者静态和动态疼痛情况。观察两组患者术后72 h内恶心呕吐、瘙痒、深静脉血栓(DVT)和嗜睡情况。结果BR组神经阻滞起效时间较R组缩短(P<0.05),BR组术中丙泊酚和芬太尼用量亦较R组显著减少(P<0.05)。术后不同时刻两组患者QoR-40各项评分均较术前明显升高(P<0.05)。R组患者t_(2)~3时刻情绪状态、身体舒适度、心理支持以及疼痛评分均较BR组降低(P<0.05)。R组患者t_(1)~t_(5)时刻VAS评分较BR组高(P<0.05);两组患者t_(1)~t_(5)时刻VAS评分较t_(0)低(P<0.05)。R组患者术后深静脉血栓发生率较BR组高(P<0.05)。结论老年全髋置换术患者采用布托啡诺复合罗哌卡因行腰丛和骶丛神经阻滞,可有效缩短神经阻滞起效时间,提高罗哌卡因的神经阻滞效果,降低术后静态和动态VAS评分,降低术后DVT发生率,促进老年髋关节置换术患者术后早期康复。
Objective To observe the effect of Butorphanol combined with Ropivacaine ultrasound-guided nerve block on early recovery of elderly patients undergoing hip replacement.Methods 90 patients(ASA I-II,65-78 years old,45~67 kg)with total hip replacement were selected.All patients were randomly divided into Ropivacaine group(R group)and Butorphanol combined with Ropivacaine group(BR group),45 cases in each group.B-ultrasound guided lumbosacral and sacral plexus block were performed.In Group R,30 mL and 20 mL of 0.3%Ropivacaine were given for lumbosacral plexus and sacral plexus block respectively.Butorphanol(20μg/kg)was added into 0.3%Ropivacaine local anesthetic solution in BR group,and 30 mL and 20 mL of 0.3%Ropivacaine containing Butorphanol were given to lumbosacral plexus and sacral plexus block respectively.The changes of blood pressure,heart rate and oxygen saturation were recorded in 5min preoperatively(T_(0)),5 minutes(T_(1)),15 minutes(T_(2)),30 minutes(T_(3))and 30 minutes(T_(4)),60 minutes(T_(5))and 120 minutes(T 6)after nerve block.The onset time of nerve block and the dosage of Propofol and Fentanyl were recorded.The Qor-40 scale and VAS score were done at_(3)0 min preoperatively(t_(0)),and 6 h(t_(1)),12 h(t_(2)),24 h(t_(3)),48 h(t_(4))and 72 h(t_(5))after operation.Nausea and vomiting,pruritus,deep vein thrombosis and drowsiness were observed in 72 hours after operation.Results The onset time of nerve block was shorter in BR group(P>0.05),and the dosage of Propofol and Fentanyl was also lower in BR group(P>0.05).The Qor-40 scores of the two groups were significantly higher postoperatively(P<0.05).The emotional state,physical comfort,psychological support and pain score at t_(2)~3 were higher in BR group(P<0.05).The VAS score was higher in BR group(P<0.05).The incidence of DVT was higher in R group(P<0.05).Conclusion Butorphanol combined with Ropivacaine can effectively shorten the onset time of nerve block,improve the effect of Ropivacaine nerve block,reduce the static and dynamic VAS score,and promote
作者
罗一
李佳蓓
王娜
汪芳俊
LUO Yi;LI Jiabei;WANG Na;WANG Fangjun(Department of Anesthesiology,Guangyuan People’s Hospital,Guangyuan 628000,China;Department of Anesthesiology,North Sichuan Medical College,Nanchong 637000,China)
出处
《湖北民族大学学报（医学版）》
2021年第2期41-45,共5页
Journal of Hubei Minzu University(Medical Edition)
基金
四川省医学会基金课题(EH-MN14-06)。
