摘要
目的分析超声引导下神经阻滞复合全身麻醉对全膝关节置换术患者镇痛效果及血流动力学的影响。方法选择2019年1月至2021年6月福建医科大学附属龙岩市第一医院收治的80例全膝关节置换术患者作为研究对象,采用随机数字表法分为对照组(n=40)和观察组(n=40)。对照组采用全身麻醉,观察组采用超声引导下腰丛坐骨神经阻滞复合全身麻醉。比较两组患者术后视觉模拟评分法(VAS)评分、镇痛情况、麻醉药物使用剂量及血流动力学变化。结果观察组插管时、拔管时心率、平均动脉压低于对照组,差异有统计学意义(P<0.05)。观察组术后VAS评分低于对照组,第一次需求自控镇痛泵(PCA)距离清醒拔管的时间长于对照组,麻醉恢复时间短于对照组,镇痛泵按压次数、术后24 h内舒芬太尼使用量少于对照组,患者镇痛满意度评分高于对照组,差异有统计学意义(P<0.05)。观察组丙泊酚、瑞芬太尼及舒芬太尼的剂量均少于对照组,差异有统计学意义(P<0.05)。两组的麻醉时间比较,差异无统计学意义(P>0.05)。观察组的苏醒、麻醉时间短于对照组,差异有统计学意义(P<0.05)。结论采用超声引导下腰丛坐骨神经阻滞复合全身麻醉可维持平稳的血流动力学,镇痛效果好,可有效减轻患者疼痛,减少麻醉镇痛药物的使用剂量,应用价值高。
Objective To analyze the effect of ultrasound-guided nerve block combined with general anesthesia on analgesia and hemodynamics in patients with total knee replacement.Methods A total of 80 patients with total knee replacement treated in Longyan First Hospital Affiliated to Fujian Medical University from January 2019 to June 2021 were selected as the research objects.They were divided into control group(n=40)and observation group(n=40)by random number table method.The control group were treated with general anesthesia,and the observation group were treated with ultrasound-guided lumbar plexus sciatic nerve block combined with general anesthesia.The visual analogue scale(VAS)score,analgesic situation,anesthetic dosage and hemodynamic changes were compared between the two groups.Results The heart rate and mean artery pressure of the observation group during intubation and extubation were higher than those of the control group,the differences were statistically significant(P<0.05).The VAS score of the observation group was lower than that of the control group,the time from the first demand for patient-controlled analgesia pump(PCA)to conscious extubation was longer than that of the control group,the recovery time of anesthesia was shorter than that of the control group,the pressing times of analgesia pump and the use of Sufentanil within 24 hours after operation were less than those of the control group,and the score of patients′satisfaction with analgesia was higher than that of the control group,the differences were statistically significant(P<0.05).The doses of Propofol,Remifentanil and Sufentanil in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in anesthesia time between the two groups(P>0.05).The recovery time and extubation time of the observation group were shorter than those of the control group,the differences were statistically significcant(P<0.05).Conclusion Using ultrasound-guided nerve block combined with general anesthesia can maintain stable hemodynamics and have good analgesic effect.It can effectively reduce patients′pain and reduce the dosage of narcotic analgesics.It has high application value.
作者
刘颖
涂芸芸
黄冰
LIU Ying;TU Yunyun;HUANG Bing(Department of Anesthesiology,Longyan First Hospital Affiliated to Fujian Medical University,Fujian Province,Longyan 364000,China)
出处
《中国当代医药》
CAS
2022年第18期115-118,122,共5页
China Modern Medicine
作者简介
通讯作者:黄冰。
