股神经阻滞复合全身麻醉在老年膝关节置换术患者中的应用

目的 探讨股神经阻滞复合全身麻醉在老年膝关节置换术患者中的应用。方法 将2018年1月～2019年6月在我院骨科行膝关节置换术的60例老年患者按麻醉方式不同分为两组,对照组仅用全身麻醉,观察组使用股神经阻滞复合全身麻醉,对比两组的不同时间点MAP和HR变化、各项麻醉指标变化、术后不同时间点VAS疼痛评分及MMSE评分变化。结果 两组HR、MAP均在麻醉诱导后下降,术中较为平稳,各不同时间点两组比较无明显差异(P0.05);观察组麻醉时间明显长于对照组,而苏醒时间、拔管时间明显短于对照组,丙泊酚、瑞芬太尼用量、静脉镇痛自控用药总量明显少于对照组(P0.05);观察组术后12 h、24 h、48 h的VAS疼痛评分明显低于对照组,而MMSE评分明显高于对照组(P0.05)。结论 股神经阻滞复合全身麻醉在老年膝关节置换术患者中的应用效果显著,对血流动力学影响小,能有效减轻术后疼痛,降低对认知功能的损伤,抑制炎症反应,具有积极的临床意义。

Application of femoral nerve block combined with general anesthesia in elderly patients with knee arthroplasty

Objective To investigate the application of femoral nerve block combined with general anesthesia in elderly patients undergoing knee arthroplasty surgery.Methods Sixty elderly patients undergoing knee arthroplasty in orthopedics department of our hospital from January 2018 to June 2019 were divided into two groups according to the type of anesthesia.The control group was only treated with general anesthesia,and the observation group was treated with femoral nerve block combined with general anesthesia.The changes of MAP and HR,changes of various anesthesia indexes,changes of VAS pain score and MMSE score at different time points after surgery between the two groups were compared.Results The HR and MAP of the two groups decreased after induction of anesthesia,and were relatively stable during the operation.There were no significant differences at different time points between two groups(P>0.05).The anesthesia time in the observation group was significantly longer than that in the control group,and the wake-up time and extubation time were significantly shorter than those of the control group.The amount of propofol,remifentanil,and the total amount of intravenous analgesic self-controlled medication in the observation group were significantly less than those in the control group(P<0.05).The observation group had significantly lower VAS pain scores at 12 h,24 h,and 48 h after operation than those in the control group.And the MMSE score was significantly higher than that of the control group(P<0.05).Conclusion The application of femoral nerve block combined with general anesthesia in elderly patients with knee arthroplasty has a significant effect,and has a small effect on hemodynamics,which can effectively reduce postoperative pain,reduce cognitive damage,and inhibit inflammatory reactions,and has positive clinical significance.