超声引导股神经联合坐骨神经阻滞用于老年膝关节镜手术效果观察

目的 探讨超声引导股神经联合坐骨神经阻滞用于老年患者膝关节镜手术的效果.方法 选择广州市番禺区中心医院骨科于2015年1月至2016年12月期间收治的60例老年膝关节镜手术患者为研究对象,根据随机数表法分为观察组和对照组,每组30例,对照组予腰硬联合麻醉,观察组则在超声引导下行股神经联合坐骨神经阻滞麻醉,比较两组患者不同时点麻醉前(T0)、手术开始(T1)、手术进行60 min(T2)、手术进行90 min(T3)]平均动脉压(MAP)、心率(HR)的变化,以及感觉及运动阻滞时间、术后疼痛程度(VAS).结果 观察组患者在T1、T2、T3时点MAP水平分别为(102.53±9.56)mmHg、(100.32±8.26)mmHg、(99.91±6.35)mmHg,均高于对照组的(92.10±8.73)mmHg、(88.74±7.42)mmHg、(89.07±6.28)mmHg,HR分别为(79.02±6.49)次/min、(80.19±7.42)次/min、(76.48±6.82)次/min,均低于对照组的(92.28±7.28)次/min、(93.42±5.83)次/min、(82.37±7.28)次/min,差异均有统计学意义(P<0.05);观察组患者感觉及运动阻滞起效时间分别为(3.25±1.08)min、(9.68±3.18)min,均长于对照组的(1.78±0.49)min、(2.35±0.89)min,且感觉及运动持续时间分别为(268.36±27.28)min、(245.37±30.26)min,明显长于对照组的(215.23±22.37)min、(190.59±21.31)min,差异均有统计学意义(P<0.05);术后10 h及术后24 h,观察组患者的VAS分别为(2.49±0.78)分、(3.09±0.94)分,均明显低于对照组的(3.58±1.13)分、(4.92±1.27)分,差异均有统计学意义(P<0.05).结论 超声引导股神经联合坐骨神经阻滞与腰硬联合麻醉相比具有血流动力学稳定、术后镇痛效果好的优点,更适用于老年膝关节镜手术麻醉.

Effect of ultrasound guided femoral nerve combined with sciatic nerve block for knee arthroscopy in elderly patients

Objective To investigate the effect of ultrasound guided femoral nerve combined with sciatic nerve block for knee arthroscopy in elderly patients. Methods A total of 60 cases of elderly patients undergoing knee arthros-copy in Department of Orthopedics of our hospital during January 2015 to December 2016 were selected and divided in-to the observation group (n=30) and the control group (n=30) according to the random number table method. The control group was treated with spinal epidural anesthesia, and the observation group was treated with ultrasound guided femoral nerve and sciatic nerve block anesthesia. The mean arterial pressure (MAP), heart rate (HR) changes before anesthesia (T0), at surgical initiation (T1), surgery 60 min (T2), surgery 90 min (T3), the sensory and motor block time, postopera-tive pain degree (VAS) of the two groups were compared. Results At T1, T2, T3, the MAP levels in the observation group were (102.53 ± 9.56) mmHg, (100.32 ± 8.26) mmHg, (99.91 ± 6.35) mmHg, respectively, which were significantly higher than corresponding (92.10±8.73) mmHg、(88.74±7.42) mmHg、(89.07±6.28) mmHg in the control group;the lev-els of HR in the observation group were (79.02 ± 6.49) times/min, (80.19 ± 7.42) times/min, (76.48 ± 6.82) times/min, re-spectively, which were significantly lower than (92.28±7.28) times/min, (93.42±5.83) times/min, (82.37±7.28) times/min in the control group (P<0.05); the sensory and motor block onset time in observation group were (3.25 ± 1.08) min, (9.68±3.18) min, respectively, which were significantly longer than (1.78±0.49) min and (2.35±0.89) min in the control group (P<0.05); the sensory and motor duration time in observation group were (268.36 ± 27.28) min, (245.37 ± 30.26) min, respectively, which were significantly longer than (215.23±22.37) min and (190.59±21.31) min in the control group (P<0.05). At postoperative 10 h and 24 h, the VAS in observation group were (2.49 ± 0.78), (3.09 ± 0.94), respectively, which were significantly lower than (3.58±1.13) and (4.92±1.27) in the control group (P<0.05). Conclusion Compared with spinal epidural anesthesia, ultrasound guided femoral nerve combined with sciatic nerve block has the advantages of stable hemodynamics and postoperative analgesia, which is more suitable for anesthesia of elderly knee arthroplasty surgery .