摘要
目的 观察超声引导下股神经联合股动脉阻滞减轻膝关节置换术患者止血带反应的安全性与有效性。方法 选择择期行膝关节置换术治疗的患者100例,年龄18~75岁,体质量指数18~30 kg/m2,ASA分级为Ⅰ-Ⅲ级;采用随机数字表法随机分为超声引导股神经联合股动脉阻滞组(NA组)和单纯股神经阻滞组(N组),每组50例。两组均在麻醉诱导前行超声引导下目标区域阻滞,待确定阻滞效果后再行麻醉诱导。两组均在喉罩全麻下行手术,术后均予以自控静脉镇痛(PCIA)。术后若患者出现视觉模拟疼痛评分(VAS)> 5分则给予静脉注射氟比洛芬酯50 mg作为补救镇痛。记录患者麻醉前(T1)、止血带充气前1 min(T2)、止血带充气后15 min(T3)、30 min(T4)、45 min(T5)、60 min(T6)的SBP、DBP、HR,记录患者术中发生止血带高血压例数,记录患者术中尼卡地平、艾司洛尔的使用剂量,记录两组术后2、6、12、24 h的动静态VAS评分,以及术后第1次补救镇痛的时间、补救镇痛的次数、首次下床活动时间和术后恶心、呕吐、谵妄、感染等不良反应发生的情况。结果 与N组比较,NA组止血带充气后T5、T6时点的SBP、DBP、HR均显著降低,止血带高血压发生率和降压药使用剂量明显降低(P <0.05),首次下床活动时间提前(P <0.05);术后两组动静态VAS评分、第1次补救镇痛时间、补救镇痛次数以及术后恶心、呕吐、谵妄、感染等不良反应发生的情况差异无统计学意义(P> 0.05)。结论 超声引导下股神经联合股动脉阻滞可安全有效地用于减轻膝关节置换术患者止血带反应中,且能够缩短术后首次下床时间,有利于患者的术后康复。
Objective To observe the safety and effectiveness of ultrasound-guided femoral nerve combined with femoral artery block to reduce tourniquet reaction in patients undergoing knee arthroplasty.Methods 100 patients(18~75 years old,body mass index 18~30 kg/m2)who were classified as gradeⅠ-Ⅲaccording to ASA standard and received unilateral total knee arthroplasty.The patients were randomly divided into two groups,the ultrasound-guided femoral nerve combined with femoral artery block with general anesthesia was utilized in group NA with 50 cases,and femoral nerve block alone with general anesthesia was used in group N with 50 cases.The target nerve block was guided by ultrasound before induction of anesthesia in both two groups,and anesthesia induction was performed after the block effect was etermined.Patients in two groups underwent surgery under general anesthesia of the laryngeal mask,and all patients under went self-controlled intravenous analgesia(PCIA).If a patient had a visual analogue score(VAS)score>5 after surgery,flurbiprofenate 50 mg will be given intravenously as a remedy for anal-gesia.The patients'SBP,DBP and HR were recorded before anesthesia(T1),1 min before tourniquet inflation(T2),15 min after tourniquet inflation(T3),30 min(T4),45 min(T5),and 60 min(T6),the number of cases of tourniquet hypertension occurring in patients intraoperatively and the amount of nicardipine and esmolol were recorded,and the movement and static VAS scores at 2,6,12,and 24 h after surgery were recorded.the postoperative rescue analgesic requirements and the time of getting out of bed were recorded.The incidence of adverse reactions such as nausea,vomiting,deliriumand infection were also recorded.Results Compared with group N,SBP,DBP and HR were significantly lower in group NA at 45 and 60 min after tourniquet inflation,and the incidence of tourniquet hypertension and the amount of nicardipine and esmolol were also significantly lower(P<0.05),and the time of getting out of bed was advanced(P<0.05);the movement and static
作者
凡小庆
郑晓静
胡玲
FAN Xiaoqing;ZHENG Xiaojing;HU Ling(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)
出处
《实用医学杂志》
CAS
北大核心
2024年第6期796-800,806,共6页
The Journal of Practical Medicine
基金
国家自然科学基金项目(编号:82104208)。
关键词
超声
膝关节
置换
神经阻滞
气压止血带
ultrasound
the knee joint
replacement
nerve block
Pneumatic tourniquet
