髂筋膜间隙阻滞复合喉罩全麻在高龄髋关节置换术患者中的应用

发布时间：2018-01-19 02:33

  本文关键词： 髂筋膜阻滞 蛛网膜下隙阻滞 髋置换关节成形术 岁以上老年人 喉罩麻醉　出处：《第二军医大学学报》2017年04期 　论文类型：期刊论文

【摘要】：目的回顾比较髂筋膜间隙阻滞(同时阻滞股神经、股外侧皮神经和闭孔神经)复合喉罩全麻与蛛网膜下隙阻滞应用于80岁以上人工股骨头置换术患者(非骨水泥型)的优劣性,探讨适合骨科高龄患者的个体化麻醉方案。方法回顾性分析98例80岁以上人工股骨头置换术患者的麻醉相关资料,其中髂筋膜间隙阻滞复合喉罩全麻44例(G组),蛛网膜下隙阻滞54例(S组),美国麻醉医师协会(ASA)分级为Ⅱ~Ⅳ级。记录麻醉诱导前以及诱导后5、10、15、20、30min时的平均动脉压(MAP)和心率(HR),术前及术后即刻、术后6h、术后24h的疼痛视觉模拟评分(VAS);记录麻黄碱使用次数、合并疾病、不良反应发生情况、手术后住院天数及术前、术后1d睡眠质量;调查手术医生对麻醉方案的满意度。结果两组术前年龄、性别、体质量指数等差异无统计学意义,G组患者ASAⅣ级例数多于S组(P0.05)。术后6、24h时G组VAS评分低于S组(P0.01),镇痛效果满意。两组麻醉诱导前及诱导后不同时间点血流动力学差异无统计学意义;G组麻黄碱使用次数多于S组(P0.01),S组术后尿潴留的发生率高于G组(P0.05)。两组手术后住院天数差异无统计学意义(P0.05)。结论对高龄髋关节置换患者需根据患者的具体情况选择麻醉方案。在病例选择适当的情况下,髂筋膜阻滞复合喉罩全麻与蛛网膜下隙阻滞相比术后镇痛时间长,安全可行。
[Abstract]:Objective to compare the effect of iliofascial space block on femoral nerve block. Lateral femoral cutaneous nerve and obturator nerve) combined with laryngeal mask general anesthesia and subarachnoid block were used in patients over 80 years old in artificial femoral head replacement (non-bone cement type). Methods the anesthetic data of 98 patients over 80 years old with artificial femoral head replacement were analyzed retrospectively. Iliofascial space block combined with laryngeal mask general anesthesia was used in 44 cases of G group and subarachnoid space block in 54 cases of group S). The average arterial pressure (MAPP) and heart rate (HRR) were recorded before anesthesia induction and 30 minutes after induction. The visual analogue score of pain was assessed before and immediately after operation, 6 hours after operation and 24 hours after operation. The frequency of ephedrine use, associated diseases, adverse reactions, postoperative hospitalization days and sleep quality before operation and 1 day after operation were recorded. Results there was no significant difference in preoperative age, sex, body mass index between the two groups. The number of ASA 鈪，

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