超声引导下肢神经阻滞复合右美托咪定持续泵注在老年重危患者髋关节置换术中的应用

发布时间：2018-04-21 17:22

本文选题：超声引导 + 神经阻滞　；参考：《广东医学》2017年07期

【摘要】：目的探讨超声引导下肢神经阻滞复合右美托咪定持续泵注在老年重危患者髋关节置换术中的临床效果和应用价值。方法选取40例行单侧人工髋关节置换术合并有2种以上重危疾病的患者,随机分为神经阻滞组(A组)和全身麻醉组(B组),A组采用超声引导下腰丛+坐骨神经阻滞复合持续泵注右美托咪定,B组采用静脉泵注右美托咪定复合全身麻醉,术后两组均持续静脉镇痛48h。记录两组患者入室后(T0)、麻醉诱导后即刻(T1)、麻醉诱导后5 min(T2)、麻醉诱导后30 min(T3)、术毕时点(T4)的心率(HR)、血氧饱和度(SpO_2)、平均动脉压(MAP);记录两组患者术中右美托咪定的使用剂量;记录术后患者在2、4、8、12、24以及48h的疼痛视觉模拟(VAS)评分和术后48h按压镇痛泵的次数;评估手术医生术中和术后满意度,以及患者术后满意度,记录术后并发症的发生情况。结果两组患者麻醉时间、手术时间和输血量比较差异无统计学意义(P0.05)。A组T1~T4时点的MAP、SpO_2及T4时点的HR与T0差异均无统计学意义(P0.05),而T1、T2和T3时点的HR慢于T0时点,差异有统计学意义(P0.05)。B组T1~T4时点的SpO_2与T0比较差异均无统计学意义(P0.05),T1、T4时点的HR和T4时点的MAP高于T0时点,而T2、T3时点的HR和T1~T3时点的MAP低于T0时点,差异均有统计学意义(P0.05)。两组各时点SpO_2以及T0时点的HR、MAP相互比较差异无统计学意义(P0.05),但其余各时间点的HR、MAP比较差异均有统计学意义(P0.05)。A组右美托咪定的使用剂量少于B组,差异有统计学意义(P0.05)。A组在术后2、4、8和12h静息和运动时的疼痛VAS评分均显著低于B组(P0.05),但术后24和48h静息和运动时的疼痛VAS评分差异无统计学意义(P0.05)。B组患者自控镇痛有效按压次数明显高于A组(P0.05)。A组有4例(10%)术后出现明显的不良反应,B组有11例(27.5%)术后出现明显不良反应,差异有统计学意义(P0.05)。结论持续泵注右美托咪定复合腰丛+坐骨神经阻滞用于老年重危患者的髋关节置换术安全且有效,能够使血流动力学维持更加稳定,有效地减少了并发症的发生率,术后镇痛效果较好,是老年重危患者下肢手术一种较为理想的麻醉方式。
[Abstract]:Objective to investigate the clinical effect and application value of ultrasound guided nerve block combined with dexmetomidine continuous pump in hip arthroplasty in elderly patients with severe risk. Methods 40 patients who underwent unilateral hip replacement combined with more than 2 serious diseases were selected. They were randomly divided into nerve block group (group A) and general anesthesia group (group B). The lumbar plexus sciatic nerve block combined with continuous pump injection of right metomidine was used in group B with intravenous injection of dexmetomidine combined with general anesthesia. Postoperative intravenous analgesia was performed for 48 hours in both groups. The heart rate (HRT), blood oxygen saturation (SPO _ 2) and mean arterial pressure (MAPP) were recorded in the two groups, including T _ 0, T _ 1, T _ 2, T _ 2, T _ 3 and T _ 4 at 30 min after anesthesia induction, SPO _ 2 and MAPP, respectively, and the dose of right metomidine during operation was recorded in both groups. The visual analogue pain (VASs) scores and the times of pressing analgesia pump 48 hours after operation were recorded, and the patients' satisfaction during and after operation were evaluated, and the occurrence of postoperative complications was recorded. Results there was no significant difference in anesthesia time, operation time and blood transfusion volume between the two groups. There was no significant difference in HR and T0 between T1~T4 SpO2 and T4 in group A, but the HR at T2 and T3 was slower than that at T0. There was no significant difference between SpO_2 and T0 at T1~T4 time in group P0.05. There was no significant difference in MAP between T0 and T0. The MAP of T4 and T4 was higher than that of T0, but the MAP of HR and T1~T3 at T2T 3 was lower than that at T0, and the difference was statistically significant. There was no significant difference in SpO_2 between the two groups at each time point and at T0 time point (P 0.05), but there were significant differences in the other time points (P 0.05). The dosage of dexmetomidine in group A was lower than that in group B. There was significant difference in the VAS scores of rest and exercise in group A (P 0.05), but there was no significant difference between group A (P 0.05) and group B (P 0.05) in 24 and 48 h postoperatively. There was no significant difference in VAS score between group B and group B (P 0.05) in patient controlled analgesia at 24 and 48 hours after the operation, however, there was no significant difference in VAS score between group B and group B at 24 and 48 hours postoperatively. The number of effective compressions was significantly higher than that in group A (P 0.05). Group A (n = 4) had obvious adverse reactions (n = 11) and group B (n = 11) had significant adverse reactions. The difference was statistically significant (P 0.05). Conclusion continuous infusion of dexmetidine combined with lumbar plexus sciatic nerve block is safe and effective for hip arthroplasty in elderly patients with severe risk. It can keep hemodynamics more stable and effectively reduce the incidence of complications. Postoperative analgesia is an ideal anaesthesia for lower extremity surgery in elderly patients.
【作者单位】：浙江医院麻醉科;
【基金】：浙江省医药卫生科技计划项目(编号:2014KYB016)
【分类号】：R614

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