本文選題：股神經(jīng)阻滯 + 老年　； 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：外周神經(jīng)阻滯術(shù)是一種阻滯范圍局限、阻滯效果確切、鎮(zhèn)痛作用完善，，而對(duì)全身影響相對(duì)較小的麻醉及鎮(zhèn)痛技術(shù)，在臨床應(yīng)用了幾十年。隨著神經(jīng)刺激儀和超聲引導(dǎo)技術(shù)的發(fā)展，下肢外周神經(jīng)阻滯的成功率大大提高，其在高齡患者的骨科麻醉中發(fā)揮著越來越重要的作用。股神經(jīng)阻滯（Femoral NerveBlock，F(xiàn)NB）是迄今為止使用最廣泛的下肢外周神經(jīng)阻滯技術(shù)，其在下肢手術(shù)術(shù)后鎮(zhèn)痛的研究是近年來國(guó)內(nèi)外學(xué)者研究的熱點(diǎn)，目前臨床多觀察的是單次股神經(jīng)阻滯（single Femoral Nerve Block，sFNB）或連續(xù)股神經(jīng)阻滯（continuous Femoral Nerve Block，cFNB）對(duì)單側(cè)下肢手術(shù)的阻滯效果，而雙側(cè)下肢手術(shù)，仍舊采用全身麻醉或者椎管內(nèi)麻醉等傳統(tǒng)方法，本研究通過觀察sFNB復(fù)合喉罩全身麻醉在老年患者單側(cè)全膝關(guān)節(jié)置換術(shù)（UnilateralTotal Knee Arthroplasty，UTKA）中的臨床應(yīng)用與效果評(píng)價(jià)，進(jìn)一步探索雙側(cè)sFNB復(fù)合全身麻醉在老年患者同期雙側(cè)全膝關(guān)節(jié)置換術(shù)（SimultaneousBilateral Total Knee Arthroplasty，SBTKA）的安全性及有效性，以期為老年患者SBTKA麻醉選擇提供新的臨床依據(jù)。 第一部分sFNB復(fù)合喉罩全身麻醉在老年患者UTKA中的應(yīng)用 目的：觀察sFNB復(fù)合喉罩(Laryngeal MaskAirway，LMA)全身麻醉在老年患者UTKA中的臨床效果。方法：選擇擬行UTKA的老年患者60例，隨機(jī)分成sFNB+喉罩全身麻醉組（FLA組）、sFNB+氣管插管全身麻醉組（FGA組）和氣管插管全身麻醉組（GA組），觀察并記錄各時(shí)間點(diǎn)心率（Heart Rate，HR）、無(wú)創(chuàng)收縮壓（Systolic Blood Pressure，SBP）、無(wú)創(chuàng)舒張壓（Diastolic BloodPressure，DBP），記錄三組患者手術(shù)時(shí)間及止血帶應(yīng)用時(shí)間，術(shù)中丙泊酚、瑞芬太尼、芬太尼用量，血管活性藥物的使用及圍術(shù)期不良事件發(fā)生情況；觀察三組停止靜脈麻醉藥后蘇醒時(shí)間，拔管時(shí)間。記錄三組患者術(shù)后6h、24h、48h、72h靜息狀態(tài)的視覺模擬評(píng)分法(Visual Analogue Scale/Score，VAS)評(píng)分，術(shù)后24h、48h、72h功能訓(xùn)練狀態(tài)的VAS評(píng)分，并記錄術(shù)后鎮(zhèn)痛泵的按壓次數(shù)及不良反應(yīng)。結(jié)果：60例患者均完成了本項(xiàng)研究。麻醉用藥方面FLA組和FGA組術(shù)中丙泊酚、瑞芬太尼、芬太尼的使用量顯著低于GA組（P0.01），蘇醒時(shí)間及拔管時(shí)間與GA組比較明顯縮短（P0.05）；血流動(dòng)力學(xué)方面FLA組、FGA組在T3、T4、T5三個(gè)時(shí)間點(diǎn)的SBP顯著低于GA組（P0.05），F(xiàn)LA組、FGA組T5時(shí)間點(diǎn)的HR顯著低于GA組（P0.05）；圍術(shù)期不良反應(yīng)FLA組、FGA組蘇醒期躁動(dòng)、拔管后訴切口疼痛例數(shù)顯著低于GA組（P0.01），F(xiàn)LA組拔管后嗆咳、術(shù)后咽痛例數(shù)明顯低于FGA組和GA組，差異具有顯著性（P0.01）；VAS評(píng)分比較方面FLA、FGA組術(shù)后6h、24h靜息狀態(tài)和術(shù)后24h、48h運(yùn)動(dòng)狀態(tài)的疼痛VAS評(píng)分均顯著低于GA組同時(shí)間點(diǎn)（P 0.05），F(xiàn)LA、FGA組PCIA泵按壓次數(shù)、使用總量和加用帕瑞昔布鈉用量顯著少于GA組(P0.05)，術(shù)后不良反應(yīng)沒有差異（P0.05）。結(jié)論：sFNB復(fù)合全身麻醉，特別是復(fù)合喉罩全身麻醉優(yōu)于單純?nèi)砺樽�，可以減少術(shù)中及術(shù)后用藥，縮短蘇醒、拔管時(shí)間，降低術(shù)后早期VAS評(píng)分，且不良反應(yīng)少，可以作為老年UTKA手術(shù)的更好選擇。 第二部分雙側(cè)sFNB復(fù)合全身麻醉在老年患者SBTKA中的應(yīng)用 目的：觀察雙側(cè)sFNB復(fù)合全身麻醉在老年患者SBTKA中的可行性和安全性，并評(píng)價(jià)臨床效果。方法：選擇本院擇期行SBTKA的老年患者50例，隨機(jī)分成雙側(cè)sFNB+全身麻醉組（FGA組）和全身麻醉組(GA組)各25例，觀察相應(yīng)時(shí)間點(diǎn)記錄HR,有創(chuàng)動(dòng)脈收縮壓（SystolicArterial Pressure, SAP）、有創(chuàng)動(dòng)脈舒張壓（DiastolicArterial Pressure, DAP）、血氧飽和度（Surplus PulseO2, SpO2），記錄兩組患者手術(shù)時(shí)間及止血帶應(yīng)用時(shí)間，術(shù)中丙泊酚、瑞芬太尼、芬太尼用量，術(shù)中心血管事件及血管活性藥物的使用，觀察兩組停止靜脈麻醉藥后蘇醒時(shí)間，拔管時(shí)間。結(jié)果：45例患者完成了該研究。 FGA組患者術(shù)中丙泊酚、瑞芬太尼、芬太尼用量顯著低于GA組（P0.01）,蘇醒及拔管時(shí)間也顯著短于GA組（P 0.01）；血流動(dòng)力學(xué)方面FGA組T4、T5、T6、T7四個(gè)時(shí)間點(diǎn)的SAP顯著低于GA組（P0.05），F(xiàn)GA組T7時(shí)間上HR顯著低于GA組，差異有統(tǒng)計(jì)學(xué)意義（P0.05），F(xiàn)GA組蘇醒期躁動(dòng)、拔管后訴切口疼痛例數(shù)顯著低于GA組（P0.05）；術(shù)后VAS評(píng)分FGA組術(shù)后6h、24h、48h靜息狀態(tài)VAS評(píng)分和術(shù)后48h運(yùn)動(dòng)狀態(tài)的疼痛VAS評(píng)分均顯著低于GA組同時(shí)間點(diǎn)（P 0.01）；術(shù)后鎮(zhèn)痛藥的使用上FGA組顯著少于GA組，嗜睡、惡心嘔吐不良反應(yīng)發(fā)生也顯著少于GA組(P0.05)；圍手術(shù)期圍術(shù)期應(yīng)激反應(yīng)沒有顯著性差異（P0.05）。結(jié)論：雙側(cè)sFNB復(fù)合全身麻醉是安全的、有效的，可以減少術(shù)中及術(shù)后用藥，縮短蘇醒、拔管時(shí)間，降低術(shù)后早期VAS評(píng)分，且不良反應(yīng)少，可以作為老年SBTKA手術(shù)的選擇。
[Abstract]:Peripheral nerve block is a kind of block limited, accurate block effect and perfect analgesic effect, while the anesthesia and analgesic technique which has relatively small influence on the whole body has been applied for several decades. With the development of the nerve stimulator and ultrasound guided technique, the success rate of peripheral peripheral nerve obstruction is greatly improved, and it is in the Department of orthopedics of the elderly patients. Anaesthesia plays a more and more important role. Femoral NerveBlock (FNB) is the most widely used peripheral nerve block in the lower extremities so far. Its research on postoperative analgesia after lower extremity surgery is a hot spot at home and abroad. At present, the clinical observation is the single femoral nerve block (single Femoral Nerve B). Lock, sFNB) or continuous femoral nerve block (continuous Femoral Nerve Block, cFNB) for unilateral lower extremities surgery, while bilateral lower extremity surgery still uses traditional methods such as general anesthesia or intraspinal anesthesia. This study was conducted through the observation of sFNB complex laryngeal mask body drunken in elderly patients with unilateral total knee arthroplasty (UnilateralTotal). The clinical application and effect evaluation in Knee Arthroplasty, UTKA, and further explore the safety and effectiveness of bilateral total knee replacement (SimultaneousBilateral Total Knee Arthroplasty, SBTKA) for bilateral sFNB combined general anesthesia in the elderly in order to provide a new clinical basis for the selection of SBTKA anesthesia for the elderly patients.
Part one application of sFNB combined laryngeal mask airway in elderly patients with UTKA
Objective: To observe the clinical effect of sFNB combined with Laryngeal MaskAirway (LMA) general anesthesia in the elderly patients with UTKA. Methods: 60 cases of elderly patients with UTKA were selected, randomly divided into sFNB+ laryngeal mask general anesthesia group (FLA group), sFNB+ tracheal intubation general anesthesia group (FGA group) and tracheal intubation general anesthesia group (GA group), observed and recorded each time. Heart Rate (HR), Systolic Blood Pressure (SBP), non invasive diastolic pressure (Diastolic BloodPressure, DBP), the time of operation and the use of tourniquet in three groups of patients, the use of propofol, Reventa Ni, fentanyl, the use of blood tube active drugs and the occurrence of adverse events in the perioperative period, and the observation of the three groups. A visual analogue scale (Visual Analogue Scale/Score, VAS) score for 6h, 24h, 48h and 72h after operation was recorded in three groups of patients after the anesthesia, and the VAS scores of the postoperative 24h, 48h, 72h functional training state were recorded, and the times and adverse reactions of the postoperative analgesia pump were recorded and the results were completed in 60 patients. The use of propofol, Reventa Ni, and fentanyl in group FLA and FGA was significantly lower than that in group GA (P0.01). The awakening time and extubation time were significantly shorter than those in the GA group (P0.05); the FLA group in the hemodynamics, FGA group at T3, T4, and T5 were significantly lower than those in the group of T3, T4, and T5. HR was significantly lower than group GA (P0.05); in group FLA, group FGA was restless in group FGA, and the number of pain cases of incision after extubation was significantly lower than that of group GA (P0.01). The number of postoperative pain in FLA group was obviously lower than that of FGA group and GA group, and the difference was significant (P0.01). The pain VAS score of 48h motor state was significantly lower than that in group GA at the same time point (P 0.05), FLA, FGA group PCIA pump press times, total use and dosage of parecoxib sodium were significantly less than GA group (P0.05), and there was no difference in postoperative adverse reaction (P0.05). Conclusion: sFNB compound general anesthesia, especially compound laryngeal mask general anesthesia, is superior to simple general anesthesia. It can reduce the use of medication during and after operation, shorten the awakening, extubation time, reduce the early VAS score after the operation, and have less adverse reactions, which can be used as a better choice for the elderly UTKA operation.
The application of second parts of bilateral sFNB combined general anesthesia in elderly patients with SBTKA
Objective: To observe the feasibility and safety of bilateral sFNB combined general anesthesia in elderly patients with SBTKA, and to evaluate the clinical effect. Methods: 50 elderly patients with SBTKA were selected and divided into 25 cases of bilateral sFNB+ general anesthesia group (group FGA) and general anesthesia group (group GA), and the corresponding time points were observed and the arterial contraction was recorded at the corresponding time point. Pressure (SystolicArterial Pressure, SAP), the arterial diastolic pressure (DiastolicArterial Pressure, DAP), blood oxygen saturation (Surplus PulseO2, SpO2), record two groups of patients' operation time and tourniquet time, operation propofol, remifentanil, fentanyl dosage, operation center vascular events and vasoactive drugs use, observe the two groups of stop Results: 45 patients completed the study. In group FGA, the dosage of propofol, Reventa Ni, fentanyl was significantly lower than that of group GA (P0.01), and the time of awakening and extubation was significantly shorter than group GA (P 0.01); the SAP of the four time points of the hemodynamic square FGA group T4, T5, T6, T7 was significantly lower than that of the GA group. .05), in group FGA, HR was significantly lower than that in group GA, and the difference was statistically significant (P0.05), group FGA was restless, and the number of pain cases of incision after extubation was significantly lower than that of GA group (P0.05). The postoperative VAS score in FGA group was significantly lower than that in the same time point (0.01). FGA group was significantly less than group GA, lethargy and nausea and vomiting were significantly less than group GA (P0.05), and there was no significant difference in perioperative stress response (P0.05) in perioperative period (P0.05). Conclusion: bilateral sFNB combined general anesthesia is safe and effective. It can reduce the use of medication during and after operation, shorten the awakening, extubation time, Reduce the early postoperative VAS score, and less adverse reactions, can be used as the choice of SBTKA surgery in the elderly.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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相關(guān)期刊論文 前1條

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本文編號(hào)：1917102