股神经阻滞复合喉罩全麻在老年患者膝关节置换术中的应用

摘要

目的：观察股神经阻滞复合喉罩全麻在老年患者人工全膝关节置换术（TKR）中的应用效果。方法择期行单侧TKR患者40例，美国麻醉协会（ASA）分级Ⅰ～Ⅲ级。随机分为股神经阻滞复合喉罩全麻组（T组），气管插管全麻组（C组），每组20例。记录麻醉诱导前（T0）、诱导后（T1）、置喉罩（管）即刻（T2）、置喉罩（管）后3 min （T3）、拔出喉罩（管）前（T4）及拔出喉罩（管）后3 min（T5）的心率（HR）、平均动脉压（MAP）、氧分压（SpO2）值。记录手术时间、麻醉时间、全麻用药量（丙泊酚、瑞芬太尼、维库溴铵）、苏醒时间、拔管时间及苏醒期躁动情况。随访术后8 h疼痛视觉模拟评分（VAS）及术后咽喉疼痛发生率。结果 T组全麻药用量少于C组（P＜0．05），苏醒时间和拔管时间均短于C组（P＜0．05）。T 组苏醒期躁动、VAS评分大于4分及术后咽喉痛发生率均少于C组（P＜0．05）。两组诱导后T1、T0时段HR、MAP均下降（P＜0．05），但两组下降程度间比较，差异无统计学意义（P＞0．05）。两组患者的MAP、HR在T3时段与 T0比较，均无明显变化（P＞0．05）。 HR、MAP在 T2、T4、T5分别与T0比较，T组无明显变化（P＞0．05），C组明显升高（P＜0．05），两组间比较差异有统计学意义（P＜0．05）。两组患者的SpO2在手术前后均无明显变化（P＞0．05）。结论在老年患者TKR中应用股神经阻滞联合喉罩全麻可减少全麻药用量，降低应激反应，减轻术后疼痛，减少麻醉相关并发症，是一种更安全、更舒适的麻醉方式。%Objective To evaluate the effect of femoral nerve block combined with general anesthesia (GA) by laryngeal mask airway(LMA) in the aged patients undergoing total knee arthroplasty .Methods Forty patients with American Society of Anesthesiology grades Ⅰ-Ⅲ undergoing total knee replacement were randomly divided into two groups ,20 patients in each group ,T group received GA with LMA and femoral nerve block ,C group received GA with tracheal intubation .The changes of HR ,MAP and SpO2 were recorded before anesthesia induction (T0 ) ,after anesthesia induction(T1 ) ,at the time of tracheal intubation or LMA insertion(T2 ) ,3 minutes after tracheal intubation or LMA insertion(T3 ) ,the time of extraction or LMA removal (T4 ) ,3 minutes after extraction or LMA removal (T5 ) .The persistent time of operation and anesthesia ,anesthetic dosages(propofol ,remifentanil and vecuronium bro-mide) ,awake time of anesthesia ,extraction time and the restlessness after waked from anesthesia were recorded .Vis-ual analog scale(VAS)pain scores after operation 8 h and the incidence of throat pain were recorded .Results The an-esthetic dosages ,the awake time and extraction time of the group T were less than those in the group C (P<0 .05) . The situation of restlessness after waked from anesthesia and the incidence of throat pain ,cases of VAS pain scores a-bove 4 were less than the group C (P< 0 .05) .Compared the level of HR and MAP between the two groups ,they were decreased at T1 and T0 in both groups(P<0 .05) ,but there were no significant differences between the two groups (P>0 .05) ,there were no significant differences between T3 and T0(P>0 .05) .Compared the level of HR and MAP at T2 ,T4 ,and T5 with those at T0 ,there were significant differences in group C (P<0 .05) ,but no differ-ences were noted in group T (P>0 .05) .There were significant differences between two groups (P<0 .05) .The level of SpO2 has no significant differences between the two groups during the operation .Conclusion Compared with the traditional endotracheal intubation ,femoral nerve block combined with laryngeal mask anesthesia in elderly patients undergoing total knee Arthroplasty could reduce the dosage of general anesthetics ,stress responses ,and the complica-tions associated with anesthesia ,relieve postoperative pain ,which was a safer and more comfortable anesthesia method .