CAJ | 학술논문

目的探讨B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞麻醉与全身麻醉在老年患者下肢膝关节手术中的应用. 方法将我院2014年6月至2015年6月收治的110例有椎管内麻醉高风险或禁忌证的老年下肢膝关节手术患者按随机数字法分成观察组(55例)和对照组(55例)两组.观察组采用B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞;对照组采用全身麻醉.记录并对比两组不同方案的麻醉操作及麻醉起效的时间、麻醉后心率与平均动脉压(MAP)的变化、补液量和升降压药的使用量、不良反应、患者麻醉费用、麻醉效果. 结果观察组麻醉准备和操作时间(8.3±1.7)min与对照组(7.7±1.2)min相当(t=1.661,P=0.139);麻醉起效时间(10.3±1.4)min比对照组(3.2±0.6)min长(t=50.180,P＜0.01);观察组与对照组MAP在麻醉后5 min(89.24±8.30) mmHg;(77.90±8.05) mmHg以及手术结束时(96.60±8.03)mmHg;(106.22±8.88)mmHg变化明显(P＜0.05);观察组与对照组在输液量(1150.9±231.6)ml、(1400.0±256.5)ml、升压药用量(3.91±1.21)mg、(10.83±2.19) mg、降压药用量(1.80±0.37)mg、(8.27±1.25)mg、麻醉费用(1239.1±202.9)元、(2307.2±205.6)元、麻醉中和麻醉后不良事件发生率(3.6％、18.2％)差异均有统计学意义(t=6.024、2.760、4.420,27.430,x2=8.510,均P＜0.01或0.05);麻醉效果两组差异无统计学意义(x2=1.657,P=0.198). 结论 B超和神经刺激仪联合引导实施股神经复合股外侧皮神经阻滞麻醉在老年患者下肢膝关节手术中应用更简单安全实用,并发症更少,费用更低,患者满意度更高.
목적 탐토B초화신경자격의연합인도실시고신경복합고외측피신경조체마취여전신마취재노년환자하지슬관절수술중적응용. 방법 장아원2014년6월지2015년6월수치적110례유추관내마취고풍험혹금기증적노년하지슬관절수술환자안수궤수자법분성관찰조(55례)화대조조(55례)량조.관찰조채용B초화신경자격의연합인도실시고신경복합고외측피신경조체;대조조채용전신마취.기록병대비량조불동방안적마취조작급마취기효적시간、마취후심솔여평균동맥압(MAP)적변화、보액량화승강압약적사용량、불량반응、환자마취비용、마취효과. 결과 관찰조마취준비화조작시간(8.3±1.7)min여대조조(7.7±1.2)min상당(t=1.661,P=0.139);마취기효시간(10.3±1.4)min비대조조(3.2±0.6)min장(t=50.180,P＜0.01);관찰조여대조조MAP재마취후5 min(89.24±8.30) mmHg;(77.90±8.05) mmHg이급수술결속시(96.60±8.03)mmHg;(106.22±8.88)mmHg변화명현(P＜0.05);관찰조여대조조재수액량(1150.9±231.6)ml、(1400.0±256.5)ml、승압약용량(3.91±1.21)mg、(10.83±2.19) mg、강압약용량(1.80±0.37)mg、(8.27±1.25)mg、마취비용(1239.1±202.9)원、(2307.2±205.6)원、마취중화마취후불량사건발생솔(3.6％、18.2％)차이균유통계학의의(t=6.024、2.760、4.420,27.430,x2=8.510,균P＜0.01혹0.05);마취효과량조차이무통계학의의(x2=1.657,P=0.198). 결론 B초화신경자격의연합인도실시고신경복합고외측피신경조체마취재노년환자하지슬관절수술중응용경간단안전실용,병발증경소,비용경저,환자만의도경고.
Objective To investigate the effect of ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia on knee joint surgery in elderly patients.Methods The 110 elderly patients with spinal anesthetic contraindication and undergoing lower extremity surgery from June 2014 to June 2015 were randomly divided into observation group (n =55) and control group (n =55).The observation group received both ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block,and the control group was given general anesthesia.Anesthesia procedure,sensory block onset time,changes in heart rate and mean artery pressure (MAP) after anesthesia,the total quantity of fluids infusion,dosage of vasopressor and hypotensor,adverse anesthetic reactions,anesthetic fees,anesthetic effect were recorded.Results Anesthetic preparation and practicing time had no difference between the two groups [(8.3 ± 1.7) min vs.(7.7 ± 1.2) min,(t =1.661,P=0.139)].The block onset time was longer in observation group than in control group [(10.3 ± 1.4) min vs.(3.2±0.6) min,t=50.180,P＜0.01].The changes in MAP had significant difference between the two groups [5 min after anesthesia:(89.24 ± 8.30) mmHg and (77.90 ± 8.05) mmHg;after operation:(96.60±8.03) mmHg and (106.22±8.88) mmHg;P＜0.05].There were significant differences in the fluid infusion quantity,dosage of vasopressor and hypotensor,adverse reactions during or after anesthesia,and anesthetic fees between the two groups [(1150.9± 231.6) ml vs.(1400.0±256.5) ml,(3.91±1.21) mg vs.(10.83±2.19)mg,(1.80±0.37) mg vs.(8.27±1.25)mg,3.6％ vs.18.2％,(1239.1±202.9) Yuan vs.(2307.2±205.6) Yuan,all P＜0.05].No significant difference was found in anesthesia effect between the two groups (P =0.198).Conclusions The ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia is more simple and safe for the knee joint surgery in elderly patients,with less complications,lower cost and higher satisfaction of patients.