超声引导股神经阻滞联合全麻在老年膝关节置换术中的应用

Application of ultrasound-guided femoral nerve block combined with general anesthesia in elderly patients undergoing knee ar-throplasty

中文关键词: 老年, 膝关节置换术, 麻醉镇痛, 谵妄, 全身麻醉, 超声引导股神经阻滞

英文关键词: elderly  knee arthroplasty  anesthesia analgesia  delirium  general anesthesia  ultrasound-guided femoral nerve block

中文摘要:

      目的 观察超声引导下股神经阻滞联合全身麻醉在老年膝关节置换术中的应用效果,并观察其对预防术后谵妄的作用,为优化临床镇痛方案提供参考.方法 选取2023年2月-2024年2月中国人民解放军陆军第七十三集团军医院收治的102例老年膝关节置换术患者,随机分为研究组和对照组,每组51例.对照组予以全身麻醉,研究组予以超声引导下股神经阻滞联合全身麻醉,2组术后均接受静脉自控镇痛至术后48 h.比较2组术后疼痛水平、镇痛补救情况、运动阻滞情况、镇痛相关不良反应、认知功能、术后谵妄发生率.结果 研究组术后6、12、24、48 h时的VAS评分[(2.91±0.65)、(2.95±1.04)、(2.86±1.21)、(3.12±0.87)分)]均低于对照组[(3.03±0.84)、(3.25±1.13)、(3.20±1.19)、(3.47±1.35)分],差异均有统计学意义(P＜0.05);研究组曲马多用量低于对照组[(53.79±10.28)mg vs(68.14±12.29)mg,P＜0.05]、镇痛补救率低于对照组(13.73％vs 31.37％,P＜0.05);研究组术后 6、12、24、48 h时的改良 Bromage 评分(0.55±0.24、1.25±0.33、3.20±0.77、4.74±0.51)均分别低于对照组(0.63±0.28、1.39±0.40、3.46±0.61、4.81±0.37),差异均有统计学意义(P＜0.05);2组镇痛相关不良反应总发生率差异无统计学意义(13.73％vs 17.65％,P＞0.05);研究组术后72 h时简易精神状态量表(MMSE)得分高于对照组的[(28.53±0.21)分vs(28.22±0.33)分,P＜0.05],术后72 h内谵妄发生率差异无统计学意义(1.96％vs 7.84％,P＞0.05).结论 超声引导下股神经阻滞与全身麻醉联合应用于老年膝关节置换术,可在保证镇痛效果的同时减少术后镇痛药物补救用量,且未加重下肢运动阻滞程度,镇痛相关不良反应较少,对患者术后认知功能的负面影响更小,此联合麻醉方案具有良好的镇痛效果和安全性,可使患者受益,具有一定的临床应用价值.

英文摘要:

      Objective To explore the application effects of ultrasound-guided femoral nerve block combined with gener-al anesthesia in elderly patients undergoing knee arthroplasty,observe its effect on preventing postoperative delirium,and pro-vide reference for optimizing clinical analgesia plan.Methods 102 elderly patients undergoing knee arthroplasty in Hospital of 73rd Army Group of Chinese People's Liberation Army from February 2023 to February 2024 were selected and randomly divid-ed into study group and control group,with 51 cases in each group.The study group received ultrasound-guided femoral nerve block combined with general anesthesia,while the control group adopted general anesthesia.Both groups received intravenous patient-controlled analgesia after surgery for48 h.The postoperative pain level,analgesic remedy,movement block,analgesia-related adverse reactions,cognitive function and the incidence of postoperative delirium were compared between the two groups.Results The VAS scores of the study group at 6,12,24,and 48 h after surgery[(2.91±0.65),(2.95±1.04),(2.86±1.21),(3.12±0.87)]were lower than those of the control group[(3.03±0.84),(3.25±1.13),(3.20±1.19),(3.47±1.35)],and the differences were statistically significant(P＜0.05).The dosage of tramadol in the study group was lower than that in the control group[(53.79±10.28)mg vs(68.14±12.29)mg,P＜0.05];the rate of analge-sic remedy was lower than that in the control group(13.73％vs 31.37％,P＜0.05).The scores of modified Bromage in the study group at 6,12,24,and 48 h after surgery(0.55±0.24,1.25±0.33,3.20±0.77,4.74±0.51)were lower than those in the control group(0.63±0.28,1.39±0.40,3.46±0.61,4.81±0.37),and the differences were statistically sig-nificant(P＜0.05).There was no significant difference in the total incidence of analgesia-related adverse reactions between both groups(13.73％vs 17.65％,P＞0.05).The score of Mini-Mental State Examination(MMSE)at 72 h after surgery in the study group was higher than that in the control group[(28.53±0.21)vs(28.22±0.33),P＜0.05].There was no obvi-ous difference in the incidence of delirium within 72 h after surgery between both groups(1.96％vs 7.84％,P＞0.05).Conclusion The combination of ultrasound-guided femoral nerve block and general anesthesia in elderly patients undergoing knee arthroplasty can ensure the analgesic effect and reduce the amount of postoperative analgesic drugs.It does not aggravate the degree of lower extremity movement block,has fewer analgesia-related adverse reactions,and has less negative effect on postoperative cognitive function.This combined anesthesia plan has good analgesic effect and safety,can benefit patients,and has certain clinical application value.