喉罩全身麻醉联合神经阻滞麻醉在高龄病人髋部手术中的应用

目的 观察喉罩全身麻醉联合神经阻滞在骨科高龄病人髋部手术中的应用效果.方法 选择60例年龄大于80岁行骨科髋部手术的老年病人,按单纯随机法分为神经阻滞+喉罩全麻组(Ⅰ组)、神经阻滞+气管插管全麻组(Ⅱ组),气管插管全麻组(Ⅲ组).Ⅰ、Ⅱ组病人接受超声引导下的股神经、股外侧皮神经阻滞后,于静脉诱导后分别插入i-gel喉罩与气管导管进行呼吸管理;Ⅲ组病人直接静脉诱导后实施气管插管全麻.观察并记录三组病人麻醉诱导前后及手术过程中的血流动力学变化、并发症发生情况以及术后24 h 视觉模拟评分法(VAS)评分及病房内镇痛药物需求及镇痛效果.结果 插管与拔管期收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR):Ⅰ组各指标差异无统计学意义(P>0.05),Ⅱ、Ⅲ组SBP、DBP、MAP、HR变化显著(P<0.05),但Ⅱ、Ⅲ组两组间比较差异无统计学意义.苏醒期呛咳、声音嘶哑、躁动等不良反应发生率Ⅱ、Ⅲ组明显高于Ⅰ组(P<0.05),Ⅱ、Ⅲ组两组间不良反应发生率比较差异无统计学意义(P>0.05);恶心呕吐发生率三组比较差异无统计学意义(P>0.05).术后24 h随访观察VAS评分及病房内镇痛药物需求,Ⅰ、Ⅱ组两组间比较差异无统计学意义(P>0.05),Ⅲ组术后24 h VAS评分及病房内镇痛药物需求明显高于Ⅰ、Ⅱ组(P<0.05).结论 喉罩全身麻醉联合超声引导下股神经、股外侧皮神经用于骨科高龄髋部手术病人,诱导、维持及苏醒期血流动力学平稳,术中静脉用药量明显减少,苏醒质量高,并且可以减轻早期术后疼痛,减少术后镇痛药的使用.

The effects of application of laryngeal mask combined with nerve block anesthesia in elderly patients undergoing hip operation

Objective To study the effect of application of laryngeal mask combined with nerve block anesthesia in elderly patients undergoing hip operation.Methods Sixty elderly patients received hip operation were randomly divided into three groups: nerve block and laryngeal mask anesthesia group (group Ⅰ),nerve block and tracheal intubation group (group Ⅱ) and only general anesthesia group (group Ⅲ).Group Ⅰ and Ⅱ were received femoral nerve and lateral femoral cutaneous nerve block with ultrasound guided.After induced with drug,i-gel laryngeal mask was used to manage airway.Group Ⅲ patients were used tracheal intubation to anesthesia.We observed the changes of hemodynamic,complications,VAS score in 24 h,analgesic effect and the need of analgesic drugs.Results There were no difference of SBP,DBP,MAP and HR during intubation and extubation in group I (P>0.05).There were significant difference of SBP,DBP,MAP and HR during intubation and extubation in group Ⅱ and Ⅲ (P<0.05).There were no difference of nausea and vomiting in three groups (P>0.05).There were no difference of VAS score and consume of analgesic drug in group I and Ⅱ after 24 h of operation (P>0.05).The VAS score and consume of analgesic drug were higher in group Ⅲ compared with group I and Ⅱ (P<0.05).Conclusion i-gel laryngeal mask combined with femoral nerve and lateral femoral cutaneous nerve block used in elderly patients undergoing hip operation could keep the balance of hemodynamic and reduced the consume of analgesic drug.