中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2015年
3期
314-316
,共3页
彭周全%张卫%马艳丽%李丽伟
彭週全%張衛%馬豔麗%李麗偉
팽주전%장위%마염려%리려위
神经传导阻滞%镇痛%老年人%麻醉,全身%关节成形术,置换,膝
神經傳導阻滯%鎮痛%老年人%痳醉,全身%關節成形術,置換,膝
신경전도조체%진통%노년인%마취,전신%관절성형술,치환,슬
Nerve block%Analgesia%Aged%Anesthesia,general%Arthroplasty,replacement,knee
目的 评价术前股神经阻滞用于全麻下全膝关节置换术老年患者超前镇痛的效果.方法 择期行全膝关节置换术的患者60例,性别不限,年龄65～75岁,ASA分级Ⅰ-Ⅲ级,采用随机数字表法,将其分为3组(n=20):对照组(Ⅰ组)、术前股神经阻滞组(Ⅱ组)和术后股神经阻滞(Ⅲ组).Ⅰ组不实施神经阻滞,Ⅱ组和Ⅲ组分别于麻醉诱导前即刻或手术结束即刻在超声引导下行单次股神经阻滞术.术后3组患者均采用1 μg/ml舒芬太尼行PCIA,背景输注速率2 ml/h,PCA剂量2 ml,锁定时间15 min,持续至术后2d,维持VAS评分≤3分,若VAS评分＞3分时,静脉注射氟比洛芬酯50 mg行镇痛补救.记录术后24 h内舒芬太尼单位时间用量、镇痛补救情况和不良反应的发生情况,计算舒芬太尼节俭程度.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组术后24 h内舒芬太尼单位时间用量、镇痛补救率和恶心呕吐的发生率降低(P＜0.05);与Ⅲ组比较,Ⅱ组术后24 h内舒芬太尼单位时间用量、镇痛补救率及恶心呕吐的发生率降低(P＜0.05).Ⅱ组较Ⅰ组舒芬太尼单位时间用量节俭35％,较Ⅲ组舒芬太尼单位时间用量节俭18％.结论 术前股神经阻滞对全麻下全膝关节置换术老年患者具有良好的超前镇痛效应.
目的 評價術前股神經阻滯用于全痳下全膝關節置換術老年患者超前鎮痛的效果.方法 擇期行全膝關節置換術的患者60例,性彆不限,年齡65～75歲,ASA分級Ⅰ-Ⅲ級,採用隨機數字錶法,將其分為3組(n=20):對照組(Ⅰ組)、術前股神經阻滯組(Ⅱ組)和術後股神經阻滯(Ⅲ組).Ⅰ組不實施神經阻滯,Ⅱ組和Ⅲ組分彆于痳醉誘導前即刻或手術結束即刻在超聲引導下行單次股神經阻滯術.術後3組患者均採用1 μg/ml舒芬太尼行PCIA,揹景輸註速率2 ml/h,PCA劑量2 ml,鎖定時間15 min,持續至術後2d,維持VAS評分≤3分,若VAS評分＞3分時,靜脈註射氟比洛芬酯50 mg行鎮痛補救.記錄術後24 h內舒芬太尼單位時間用量、鎮痛補救情況和不良反應的髮生情況,計算舒芬太尼節儉程度.結果 與Ⅰ組比較,Ⅱ組和Ⅲ組術後24 h內舒芬太尼單位時間用量、鎮痛補救率和噁心嘔吐的髮生率降低(P＜0.05);與Ⅲ組比較,Ⅱ組術後24 h內舒芬太尼單位時間用量、鎮痛補救率及噁心嘔吐的髮生率降低(P＜0.05).Ⅱ組較Ⅰ組舒芬太尼單位時間用量節儉35％,較Ⅲ組舒芬太尼單位時間用量節儉18％.結論 術前股神經阻滯對全痳下全膝關節置換術老年患者具有良好的超前鎮痛效應.
목적 평개술전고신경조체용우전마하전슬관절치환술노년환자초전진통적효과.방법 택기행전슬관절치환술적환자60례,성별불한,년령65～75세,ASA분급Ⅰ-Ⅲ급,채용수궤수자표법,장기분위3조(n=20):대조조(Ⅰ조)、술전고신경조체조(Ⅱ조)화술후고신경조체(Ⅲ조).Ⅰ조불실시신경조체,Ⅱ조화Ⅲ조분별우마취유도전즉각혹수술결속즉각재초성인도하행단차고신경조체술.술후3조환자균채용1 μg/ml서분태니행PCIA,배경수주속솔2 ml/h,PCA제량2 ml,쇄정시간15 min,지속지술후2d,유지VAS평분≤3분,약VAS평분＞3분시,정맥주사불비락분지50 mg행진통보구.기록술후24 h내서분태니단위시간용량、진통보구정황화불량반응적발생정황,계산서분태니절검정도.결과 여Ⅰ조비교,Ⅱ조화Ⅲ조술후24 h내서분태니단위시간용량、진통보구솔화악심구토적발생솔강저(P＜0.05);여Ⅲ조비교,Ⅱ조술후24 h내서분태니단위시간용량、진통보구솔급악심구토적발생솔강저(P＜0.05).Ⅱ조교Ⅰ조서분태니단위시간용량절검35％,교Ⅲ조서분태니단위시간용량절검18％.결론 술전고신경조체대전마하전슬관절치환술노년환자구유량호적초전진통효응.
Objective To evaluate the efficacy of preoperative femoral nerve block on preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-75 yr,scheduled for elective total knee arthroplasty,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),preoperative femoral nerve block group (group Ⅱ) and postoperative femoral nerve block group (group Ⅲ).Single-injection femoral nerve block was performed with 0.375％ ropivacaine 20 ml injected around the nerve under thc guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups,respectively.Patient-controlled intravenous analgesia (PCIA) with sufentanil (background infusion 2 ml/h,bolus dose 2 ml,lockout interval 15 min) was used until 2 days after surgery,and VAS score was maintained ≤ 3.When VAS score＞3,flurbiprofen axetil 50 mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within 24 h after surgery.Sufentanil-sparing degree was calculated.Results Compared with group Ⅰ,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly decreased within 24 h after surgery in Ⅱ and Ⅲ groups.The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in group Ⅱ than in group Ⅲ.The consumption of sufentanil per hour was decreased by 35％ in group Ⅱ as compared with group Ⅰ,and decreased by 18％ in group Ⅱ as compared with group Ⅲ.Conclusion Preoperative femoral nerve block can provide good preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.
