摘要
目的 观察罗哌卡因髋关节囊周围神经阻滞用于老年患者髋关节置换手术的效果。方法 择期行全身麻醉下髋关节置换手术老年患者80例随机分为四组,每组20例。C组麻醉诱导前不行髋关节囊周围神经阻滞,L组、M组和H组麻醉诱导前20 min分别实施0.25%、0.375%和0.5%罗哌卡因髋关节囊周围神经阻滞。记录入室后(T0)、麻醉诱导前即刻(T1)、切皮时(T2)和手术结束时(T3)的HR和MAP,记录T0、T1、术后4 h(T4)、6 h(T5)、12 h(T6)、24 h(T7)和48 h(T8)时的VAS疼痛评分。记录术中丙泊酚和雷米芬太尼用量以及拔除喉罩时间。记录不良反应发生情况。结果 与T0时比较,T1时L组、M组和H组HR、MAP降低(P<0.05)。与C组比较,T1时L组、M组和H组HR和MAP降低(P<0.05)。与T0时比较,T4~T8时四组VAS疼痛评分降低,T1时L组、M组和H组VAS疼痛评分降低(P<0.05)。与C组比较,T1、T4~T6时L组、M组和H组VAS疼痛评分降低(P<0.05);与L组比较,T5、T6时M组和H组VAS疼痛评分降低(P<0.05)。与C组比较,L组、M组和H组雷米芬太尼用量减少,拔除喉罩时间缩短,恶心呕吐、苏醒期躁动发生率降低(P<0.05);与L组比较,M组、H组雷米芬太尼用量减少,恶心呕吐发生率降低(P<0.05)。结论 罗哌卡因髋关节囊周围神经阻滞应用于老年髋部手术患者,镇痛效果满意,可减少术中麻醉药用量,缩短苏醒时间,不良反应少。与0.25%罗哌卡因比较,采用0.375%或0.5%罗哌卡因髋关节囊周围神经阻滞效果更好。
Objective To observe the efficacy of ropivacaine hip pericapsular nerve block in the elderly patients undergoing hip replacement surgery.Methods Eighty elderly patients undergoing elective hip replacement surgery under general anesthesia were randomly divided into four groups with 20 cases each.The hip pericapsular nerve block with 0.25%(group L),0.375%(group M)and 0.5% ropivacaine(group H) was performed 20 minutes before anesthesia induction.The hip pericapsular nerve block was not used in group C as the control.The HR and MAP were recorded at the time points of after entry(T0),before induction of anesthesia(T1),during skin resection(T2) and at the end of surgery(T3).The VAS pain scores were evaluated at T0,T1 and 4 hours(T4),6 hours(T5),12 hours(T6),24 hours(T7) and 48 hours(T8) after surgery.The consumptions of propofol and remifentanil and the time of laryngeal mask removal were recorded.The adverse responses were observed.Results The HR and MAP in groups of L,M and H were lower at T1 than those at T0,which were lower in groups of L,M and H than those in group C at T1(P<0.05).Compared to T0,the VAS pain scores of four groups were lower at T4-T8,which were lower in groups of L,M and H at T1(P<0.05).Compared to group C,the VAS pain score was lower at T1 and T4-T6 in groups of L,M and H(P<0.05).Compared to group L,the VAS pain score was lower at T5 and T6 in groups of M and H(P<0.05).The remifentanil consumption was less, the time of laryngeal mask removal was shorter, and the incidence of nausea and vomiting and emergence agitation was lower in groups of L,M and H than those in group C(P<0.05).The remifentanil consumption and the incidence of nausea and vomiting were less in groups of M and H than those in group L(P<0.05).Conclusion In the elderly patients undergoing hip surgery, ropivacaine hip capsule peripheral nerve block has the advantages of elevating the analgesic effect, reducing the consumption of intraoperative anesthetics, shortening the awakening time, and attenuating the adverse reponses, for which
作者
秦卫民
郑龙彬
尹宁
QIN Weimin;ZHENG Longbin;YIN Ning(Department of Anesthesiology,Affiliated Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,CHINA)
出处
《江苏医药》
CAS
2022年第5期450-453,共4页
Jiangsu Medical Journal
