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喉罩全麻复合超声引导腰丛、骶丛神经阻滞在全髋关节置换术的麻醉及术后镇痛方面的效果评价
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DOI:
作者:
朱晓岚 赵达强 张晓丽
Zhu Xiaolan,Zhao Daqiang,Zhang Xiaoli
作者单位:
上海交通大学附属第六人民医院 麻醉科
Department of Anesthesiology, Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University Medical School
关键词:
超声引导;腰丛神经阻滞;骶丛神经阻滞;喉罩;全髋关节置换术
Ultrasound guided; Lumbar plexus block ;Sacral plexus block; Laryngeal mask; total hip arthroplasty
摘要:
【摘要】 目的 评价喉罩全麻复合超声引导腰丛、骶丛神经阻滞在全髋关节置换手术的麻醉及术后镇痛的效果。方法 择期行全髋置换手术的患者40例,性别不限,年龄55~82岁,体重55~90kg,ASAⅠ~Ⅲ级,随机分为2组(n=20)。Ⅰ组(对照组)行常规气管插管静吸复合全麻,Ⅱ组(实验组)在超声引导下实施腰丛、骶丛神经阻滞后行喉罩全麻。两组术后均应用静脉自控镇痛(PCIA)方法进行镇痛。记录两组芬太尼的使用总量及插管后芬太尼的追加剂量,以及两组血管活性药物使用剂量。记录两组气管插管和插入喉罩即刻、手术切皮即刻,扩髓,假体植入以及关闭切口时的心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(SpO2)。记录入麻醉恢复室(PACU)后10、20和30 min的HR、MAP、SpO2。记录术后2、4、6、8和24 h的疼痛视觉模拟(VAS)评分。记录48 h PCIA的用药总量、有效按压次数及术后恶心呕吐(PONV)和咽喉疼痛的发生情况。 结果 在插管和切皮即刻,扩髓,假体置入,关闭切口,以及PACU中10、20和30 min时,Ⅰ组的HR均显著快于Ⅱ组同时间(P值分别<0.01、0.05),MAP均显著高于Ⅱ组同时间(P值均<0.01)。两组的SpO2 在各观察时间的差异均无统计学意义(P>0.05)。Ⅰ组术中芬太尼的使用总量、插管后芬太尼追加剂量、术中血管活性药物使用剂量、术后48 h PCIA的用药总量和PCIA有效按压次数均显著高于Ⅱ组(P值均<0.01)。Ⅰ组术后2、4、6、8、24 h的疼痛VAS评分均显著高于Ⅱ组(P值均<0.01)。Ⅰ组的PONV和咽喉疼痛的发生率分别为12/20和7/20,均显著高于Ⅱ组的3/20和1/20(P值均<0.01)。 结论 在超声引导下实施腰丛、骶丛神经阻滞复合喉罩全麻可以安全有效地应用于全髋关节置换手术。其血流动力学稳定,对生理干扰轻微并能提供良好的术后镇痛,并发症较少。
[Abstract] Objective To evaluate the efficacy of laryngeal mask(LMA) anesthesia associated with ultrasound guided lumbar plexus block and sacral plexus block in anesthesia and postoperative analgesia of total hip arthroplasty. Methods Forty ASAⅠto Ⅲ patients aged 55-82 yr,weighing 55-90kg undergoing total hip arthroplasty were randomized into 2 groups(n=20 each): groupⅠand groupⅡ. GroupⅠwas performed traditional intravenous-inhalation combined anesthesia with endotracheal intubation(ETT). GroupⅡwas received ultrasound guided lumbar plexus block and sacral plexus block and then performed laryngeal mask general anesthesia. Two groups were received patient controlled intravenous analgesia(PCIA) after operation. We recorded heart rate (HR), mean artery pressure (MAP), and saturation pulse oxygen (SpO2) of two groups on ETT/LMA insertion, cutting skin and reaming,prosthesis implanting,incision closing, and 10, 20, 30 min in post-anesthesia care unit (PACU). We recorded the dosage of fentanyl and supplement dosage of fentanyl after intubation.We also recorded the dosage of vasoactive agent during operation.Pain visual analog scale(VAS) scores on postoperative 2,4,6,8,24 h and dosage of 48h PCIA, frequencies of PCIA effective pressing as well as incidence of post-operative nausea and vomiting(PONV) and pharyngalgia were recorded too. Results HR of groupⅠon ETT/LMA insertion, cutting skin and 20, 40, 60, 80 min of operation and 10, 20, 30 min in PACU were significantly faster than those of groupⅡ(P<0.01,0.05), MAP of groupⅠwere significantly higher than those of groupⅡ(P<0.01). There were no statistical difference in SpO2 between two groups whatever in operation or in PACU (P>0.05). The dosage of fentanyl,supplement dosage of fentanyl after intubation,the dosage of vasoactive agent during operation and the dosage of 48h PCIA,frequencies of PCIA effective pressing of groupⅠwere more than those of groupⅡ(P<0.01). VAS scores on postoperative 2,4,6,8,24 h were significantly higher in groupⅠthan in groupⅡ(P<0.01).The incidence of PONV and pharyngalgia in groupⅠwere 12/20 and 7/20,which were all significantly higher than 3/20 and 1/20 in groupⅡ(P<0.01). Conclusion Laryngeal mask anesthesia associated with ultrasound guided lumbar plexus block and sacral plexus block could be used in total hip arthroplasty safely and effectively with little influence and good postoperative analgesia.It also has little complications like PONV and pharyngalgia.
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