超声引导下神经阻滞联合全身麻醉在下肢骨折手术中的应用

目的 探讨超声引导下股神经、坐骨神经阻滞联合全身麻醉在下肢骨折手术中的应用。方法 将64例接受下肢骨折手术的患者随机分为两组，对照组（n=32）采用单纯全身麻醉，联合组（n=32）采用全身麻醉联合B超引导股神经、坐骨神经阻滞。比较两组术中不同时刻血流动力学状态、麻醉药物用量、苏醒时间及苏醒后躁动发生情况。结果 T₂时刻，联合组和对照组HR、MAP均较T₁时刻明显下降（P<0.05），T₃~T₅时刻，联合组HR、MAP均与T₁时刻比较，差异无统计学意义（P>0.05），而对照组均明显高于T₁时刻水平（P<0.05）。与对照组比较，联合组术中丙泊酚、瑞芬太尼用量明显减少，苏醒时间、拔管时间明显缩短（P<0.05）。联合组苏醒后躁动的发生率、躁动程度均较对照组明显降低 （P<0.05）。结论 超声引导下神经阻滞联合全身麻醉行下肢骨折手术，可维持术中血流动力学稳定，减少镇痛药物用量，促进早期苏醒和拔管。

Application of Ultrasound-guided Nerve Blockade Combined with General Anesthesia in Lower Limb Fracture Surgery

Objective To explore the application of ultrasound-guided femoral and sciatic nerve blocks combined with general anesthesia in lower limb fracture surgery. Methods Sixty four patients who received orthopaedics surgerywere randomly divided into two groups including combined group(n=32), control group (n=32). Control group was given general anesthesia alone, combined group was givengeneral anesthesia combined with ultrasound-guided femoral and sciatic nerve blocks. The intraoperative hemodynamic state at different time, anesthetic dosage, and agitation after waking upbetween two groups were compared. Results Compared with T₁ moment, HR and MAP at T₂ moment in both groups were significantly decreased (P<0.05), while all these indicators at T₃-T₅ moment had no significant difference compared with the T₁ moment in combined group (P>0.05), while the difference was significant in control group (P<0.05).Compared with control group, combined group had less intraoperative propofoland fentanyl dosage during the surgery, shorter awakening timeand extubation time,and the difference had statistical significance(P<0.05).The incidence of agitation after waking up and degree of agitation was significantly decreased in combined group than that in control group (P<0.05). Conclusion Ultrasound-guided nerve blockade combined with general anesthesia for lower limb fracture surgery, canmaintain the stability of intraoperative hemodynamics, reduce the dosage of analgesic drugs, and promote early awakening and extubation.