中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
2期
150-153
,共4页
超声检查%神经传导阻滞%喉面罩%麻醉,全身%关节成形术,置换,膝
超聲檢查%神經傳導阻滯%喉麵罩%痳醉,全身%關節成形術,置換,膝
초성검사%신경전도조체%후면조%마취,전신%관절성형술,치환,슬
Ultrasonography%Nerve block%Laryngeal masks%Anesthesia,general%Arthroplasty,replacement,knee
目的 评价超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果.方法 择期行全膝关节置换术的病人加例,性别不限,年龄52～80岁,体重67～94 kg,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=20).Ⅰ组在气管插管下行静吸复合全麻;Ⅱ组先在超声引导下行下肢神经阻滞,然后在喉罩下行静吸复合全麻.术中和麻醉恢复室(PACU)停留期间维持HR 50～100次/min,维持MAP波动幅度不超过基础值的20%.必要时给予血管活性药物(阿托品、艾司洛尔、麻黄碱、乌拉地尔或拉贝洛尔).术后采用曲马多和氯诺昔康行PCIA(背景输注速率2 ml/h,PCA量1 ml,锁定时间15 min),维持VAS评分≤2分.记录术中和PACU停留期间血管活性药物的使用情况;记录PACU停留时间;记录术后24 h内PCA药物用量和恶心呕吐的发生情况.结果 与Ⅰ组比较,Ⅱ组术中各血管活性药物的使用率降低,PACU停留期间艾司洛尔、乌拉地尔和拉贝洛尔的使用率降低,PACU停留时间缩短,PCA药物用量减少,术后恶心呕吐发生率降低(P<0.01).结论 超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术麻醉效果较好,并发症少,术后镇痛药物用量少,优于气管插管下全麻.
目的 評價超聲引導下肢神經阻滯聯閤喉罩下全痳用于全膝關節置換術的效果.方法 擇期行全膝關節置換術的病人加例,性彆不限,年齡52～80歲,體重67～94 kg,ASA分級Ⅰ～Ⅲ級,採用隨機數字錶法,將其隨機分為2組(n=20).Ⅰ組在氣管插管下行靜吸複閤全痳;Ⅱ組先在超聲引導下行下肢神經阻滯,然後在喉罩下行靜吸複閤全痳.術中和痳醉恢複室(PACU)停留期間維持HR 50～100次/min,維持MAP波動幅度不超過基礎值的20%.必要時給予血管活性藥物(阿託品、艾司洛爾、痳黃堿、烏拉地爾或拉貝洛爾).術後採用麯馬多和氯諾昔康行PCIA(揹景輸註速率2 ml/h,PCA量1 ml,鎖定時間15 min),維持VAS評分≤2分.記錄術中和PACU停留期間血管活性藥物的使用情況;記錄PACU停留時間;記錄術後24 h內PCA藥物用量和噁心嘔吐的髮生情況.結果 與Ⅰ組比較,Ⅱ組術中各血管活性藥物的使用率降低,PACU停留期間艾司洛爾、烏拉地爾和拉貝洛爾的使用率降低,PACU停留時間縮短,PCA藥物用量減少,術後噁心嘔吐髮生率降低(P<0.01).結論 超聲引導下肢神經阻滯聯閤喉罩下全痳用于全膝關節置換術痳醉效果較好,併髮癥少,術後鎮痛藥物用量少,優于氣管插管下全痳.
목적 평개초성인도하지신경조체연합후조하전마용우전슬관절치환술적효과.방법 택기행전슬관절치환술적병인가례,성별불한,년령52～80세,체중67～94 kg,ASA분급Ⅰ～Ⅲ급,채용수궤수자표법,장기수궤분위2조(n=20).Ⅰ조재기관삽관하행정흡복합전마;Ⅱ조선재초성인도하행하지신경조체,연후재후조하행정흡복합전마.술중화마취회복실(PACU)정류기간유지HR 50～100차/min,유지MAP파동폭도불초과기출치적20%.필요시급여혈관활성약물(아탁품、애사락이、마황감、오랍지이혹랍패락이).술후채용곡마다화록낙석강행PCIA(배경수주속솔2 ml/h,PCA량1 ml,쇄정시간15 min),유지VAS평분≤2분.기록술중화PACU정류기간혈관활성약물적사용정황;기록PACU정류시간;기록술후24 h내PCA약물용량화악심구토적발생정황.결과 여Ⅰ조비교,Ⅱ조술중각혈관활성약물적사용솔강저,PACU정류기간애사락이、오랍지이화랍패락이적사용솔강저,PACU정류시간축단,PCA약물용량감소,술후악심구토발생솔강저(P<0.01).결론 초성인도하지신경조체연합후조하전마용우전슬관절치환술마취효과교호,병발증소,술후진통약물용량소,우우기관삽관하전마.
Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.
