中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2015年
8期
551-554
,共4页
麻醉,全身%关节成形术,置换,髋%髂筋膜间隙
痳醉,全身%關節成形術,置換,髖%髂觔膜間隙
마취,전신%관절성형술,치환,관%가근막간극
Anesthesia,general%Arthroplasty,replacement,hip%Fascia iliaca compartment
目的 评价髂筋膜间隙阻滞联合全身麻醉对行全髋关节置换术患者术中血流动力学、麻醉药用量、术后苏醒和镇痛等方面的影响.方法 选择拟行全髋关节置换术患者50例,按随机数字表法分为对照组和试验组,每组25例.两组术前行髂筋膜间隙阻滞,试验组给予0.25％罗哌卡因60 ml,对照组给予0.9％氯化钠60 ml,两组均接受全身麻醉.观察并记录两组患者术中用药情况和血流动力学波动情况,同时比较两组苏醒时间、拔管时间,及术后15和30 min的警觉镇静评分(改良的OAMS)和拔管后即刻视觉模拟评分(VAS).结果 麻醉维持期间丙泊酚、瑞芬太尼用量试验组低于对照组,差异有统计学意义[(250±40)mg比(420±85)mg,(300±50)μg比(600±150)μg](P＜0.01).试验组苏醒时间、拔管时间均低于对照组,差异有统计学意义[(7.2±4.5) min比(16.2 ± 7.1) min,(8.0± 2.8) min比(20.0±8.3) min](P＜ 0.01).试验组术后15和30 min改良的OAA/S均高于对照组,差异有统计学意义[(4.3±0.3)分比(3.0±1.2)分,(4.6±0.2)分比(3.9±0.8)分](P＜0.01),试验组拔管后即刻VAS低于对照组,差异有统计学意义[[1.6±0.9)分比(4.5±0.8)分](P＜0.01).试验组患者满意度优于对照组,差异有统计学意义(P＜0.05).结论 术前用0.25％罗哌卡因60 ml行髂筋膜间隙阻滞能稳定全身麻醉全髋关节置换术患者术中血流动力学,减少术中全身麻醉药用量,同时缩短苏醒时间和拔管时间,改善术后镇静镇痛.
目的 評價髂觔膜間隙阻滯聯閤全身痳醉對行全髖關節置換術患者術中血流動力學、痳醉藥用量、術後囌醒和鎮痛等方麵的影響.方法 選擇擬行全髖關節置換術患者50例,按隨機數字錶法分為對照組和試驗組,每組25例.兩組術前行髂觔膜間隙阻滯,試驗組給予0.25％囉哌卡因60 ml,對照組給予0.9％氯化鈉60 ml,兩組均接受全身痳醉.觀察併記錄兩組患者術中用藥情況和血流動力學波動情況,同時比較兩組囌醒時間、拔管時間,及術後15和30 min的警覺鎮靜評分(改良的OAMS)和拔管後即刻視覺模擬評分(VAS).結果 痳醉維持期間丙泊酚、瑞芬太尼用量試驗組低于對照組,差異有統計學意義[(250±40)mg比(420±85)mg,(300±50)μg比(600±150)μg](P＜0.01).試驗組囌醒時間、拔管時間均低于對照組,差異有統計學意義[(7.2±4.5) min比(16.2 ± 7.1) min,(8.0± 2.8) min比(20.0±8.3) min](P＜ 0.01).試驗組術後15和30 min改良的OAA/S均高于對照組,差異有統計學意義[(4.3±0.3)分比(3.0±1.2)分,(4.6±0.2)分比(3.9±0.8)分](P＜0.01),試驗組拔管後即刻VAS低于對照組,差異有統計學意義[[1.6±0.9)分比(4.5±0.8)分](P＜0.01).試驗組患者滿意度優于對照組,差異有統計學意義(P＜0.05).結論 術前用0.25％囉哌卡因60 ml行髂觔膜間隙阻滯能穩定全身痳醉全髖關節置換術患者術中血流動力學,減少術中全身痳醉藥用量,同時縮短囌醒時間和拔管時間,改善術後鎮靜鎮痛.
목적 평개가근막간극조체연합전신마취대행전관관절치환술환자술중혈류동역학、마취약용량、술후소성화진통등방면적영향.방법 선택의행전관관절치환술환자50례,안수궤수자표법분위대조조화시험조,매조25례.량조술전행가근막간극조체,시험조급여0.25％라고잡인60 ml,대조조급여0.9％록화납60 ml,량조균접수전신마취.관찰병기록량조환자술중용약정황화혈류동역학파동정황,동시비교량조소성시간、발관시간,급술후15화30 min적경각진정평분(개량적OAMS)화발관후즉각시각모의평분(VAS).결과 마취유지기간병박분、서분태니용량시험조저우대조조,차이유통계학의의[(250±40)mg비(420±85)mg,(300±50)μg비(600±150)μg](P＜0.01).시험조소성시간、발관시간균저우대조조,차이유통계학의의[(7.2±4.5) min비(16.2 ± 7.1) min,(8.0± 2.8) min비(20.0±8.3) min](P＜ 0.01).시험조술후15화30 min개량적OAA/S균고우대조조,차이유통계학의의[(4.3±0.3)분비(3.0±1.2)분,(4.6±0.2)분비(3.9±0.8)분](P＜0.01),시험조발관후즉각VAS저우대조조,차이유통계학의의[[1.6±0.9)분비(4.5±0.8)분](P＜0.01).시험조환자만의도우우대조조,차이유통계학의의(P＜0.05).결론 술전용0.25％라고잡인60 ml행가근막간극조체능은정전신마취전관관절치환술환자술중혈류동역학,감소술중전신마취약용량,동시축단소성시간화발관시간,개선술후진정진통.
Objective To investigate the efficacy of fascia iliaca compartment block combined with general anesthesia for total hip arthroplasty.Methods Fifty patients underwent total hip arthroplasty were divided into trial group or control group by random digits table method with 25 cases each.Preoperatively,both groups were given fascia iliaca compartment block with the trial group receiving 60 ml 0.25％ ropivacaine and the control group receiving 60 ml 0.9％ sodium chloride.Both groups received general anesthesia.The consumption of general anesthetics and intraoperative hemodynamic variation in the 2 groups were recorded.The recovery time,extubation time,observer's assessment of alertness/sedation score (modified OAA/S) at 15 and 30 min postoperative and visual analog score (VAS) at postoperative instantly were compared between the 2 groups.Results The consumptions of propofol and remifentanil during maintenance of anesthesia in trial group were significantly lower than those in control group,and there were statistical differences:(250 ± 40) mg vs.(420 ± 85) mg and (300 ± 50) μ g vs.(600 ± 150) μ g,P ＜ 0.01.The recovery time and extubation time in trial group were significantly shorter than those in control group,and there were statistical differences:(7.2 ± 4.5) min vs.(16.2 ± 7.1) min and (8.0 ± 2.8) min vs.(20.0 ± 8.3) min,P ＜ 0.01.The modified OAA/S at 15 and 30 min postoperative in trial group were significantly higher than those in control group,and there were statistical differences:(4.3 ± 0.3) scores vs.(3.0 ± 1.2) scores and (4.6 ± 0.2) scores vs.(3.9 ± 0.8) scores,P ＜ 0.01.The VAS at postopcrative instantly in trial group was significantly lower than that in control group,there was statistical difference:(1.6 ± 0.9) scores vs.(4.5 ± 0.8)scores,P ＜ 0.01.The degree of satisfaction in trial group was better than that in control group,and there was statistical difference (P ＜ 0.05).Conclusion Compared with general anesthesia alone for total hip arthroplasty,the fascia iliaca compartment combined with general anesthesia has better hemodynamic stability,marked reduction of consumption of general anesthetics,rapid recovery and good postoperative analgesia.
