【摘要】：目的:腰麻作為一項運用超過一百年歷史的傳統(tǒng)麻醉方式,因其所需學習周期短,便于實施及花費較少而廣泛應用于下肢手術。近十年來,隨著超聲引導技術在我國區(qū)域麻醉領域的應用而逐漸展現(xiàn)出自己獨有的優(yōu)勢。本項研究致力于比較傳統(tǒng)的腰麻與超聲引導下股神經和坐骨神經阻滯復合保留自主呼吸的全身麻醉在足踝外科手術中的運用。方法:將80位ASA I級的足踝外科手術患者隨機分成2組,每組40名患者。第一組(腰麻組)40名患者施行腰麻,于L3-4間隙進行穿刺,并在蛛網膜下腔注入0.5%羅哌卡因25mg。第二組(復合麻醉組)40名患者先進行超聲引導下股神經(0.5%羅哌卡因10ml)與坐骨神經(0.5%羅哌卡因20ml)阻滯,起效后再復合保留自主呼吸(采用3mg-5mg/kg的丙泊酚與1ug/kg的芬太尼誘導,并用喉罩作為氣道管理工具)的全身麻醉,麻醉維持采用2%-2.5%的七氟醚,氧流量為1.2L/min。比較兩組病例麻醉準備時間,施行麻醉所需時間,麻醉起效時間,手術時間,復蘇室使用時間,術后鎮(zhèn)痛時間,術后進食流質所需時間與術后進食固體食物所需時間。同時記錄基礎狀態(tài),麻醉后即刻,麻醉后5min,麻醉后10min,麻醉后15min,麻醉后30min,進入復蘇室時,離開復蘇室時七個時間段的平均動脈壓及心率。隨訪術后24h,48h,72h三個時間段的VAS評分以及頭痛,惡心嘔吐,尿潴留,穿刺部位痛等并發(fā)癥的情況。術后派出專人進行麻醉滿意度調查定量評分。結果:在時間方面,復合麻醉組患者的麻醉前等待時間,術后禁飲及禁食時間少于腰麻組患者,而復蘇室使用時間,手術操作時間,感覺阻滯時間及運動阻滯時間長于腰麻組患者,差異有統(tǒng)計學意義。在心率的比較中,復合麻醉組在麻醉后5min,麻醉后10min及麻醉后15min三個時間段的心率均低于腰麻組,差異有統(tǒng)計學意義。在血壓的比較中,復合麻醉組在麻醉后即刻,麻醉后5min及麻醉后15min三個時間段的血壓均低于腰麻組,差異有統(tǒng)計學意義。復合麻醉組在術后24h,48h,72h三個時間段的VAS評分均低于腰麻組。復合麻醉組的麻醉滿意度評分顯著高于腰麻組。結論:復合麻醉可以提高患者術后鎮(zhèn)痛效果,延長術后鎮(zhèn)痛時間,縮短術后禁食禁飲時間,提高患者滿意度。超聲引導下股神經和坐骨神經阻滯復合保留自主呼吸的全身麻醉對足踝外科的手術具有廣泛的應用前景。因其學習周期較腰麻長,且達到熟練掌握的程度較腰麻難,故而對骨科�？坡樽磲t(yī)師提出了新的挑戰(zhàn)。
[Abstract]:Objective: as a traditional anaesthesia with more than 100 years history, spinal anesthesia is widely used in lower extremity surgery because of its short learning period, easy to implement and less cost. In the last ten years, with the application of ultrasonic guidance technology in regional anesthesia in China, it gradually shows its own unique advantages. The purpose of this study was to compare the application of traditional spinal anesthesia with ultrasound guided femoral nerve and sciatic nerve block combined with autonomic breathing anesthesia in ankle and foot surgery. Methods: 80 patients with ASA I ankle surgery were randomly divided into 2 groups with 40 patients in each group. The first group (spinal anesthesia group) 40 patients underwent spinal anesthesia at the L3-4 space puncture and subarachnoid injection of 0.5% ropivacaine 25 mg. 40 patients in the second group (compound anesthesia group) received ultrasound guided femoral nerve block (0.5% ropivacaine 10ml) and sciatic nerve block (0.5% ropivacaine 20ml). The anesthesia was maintained with 2-2.5% sevoflurane, which was induced by propofol from 3mg-5mg/kg and fentanyl from 1ug/kg and used laryngeal mask as airway management tool. Oxygen flow is 1.2 L / min. The anaesthesia preparation time, anaesthesia onset time, operation time, resuscitation room use time, postoperative analgesia time, postoperative fluid consumption time and postoperative solid food consumption time were compared between the two groups. At the same time, the basic state, immediately after anesthesia, 5 minutes after anesthesia, 10 minutes after anesthesia, 15 minutes after anesthesia and 30 minutes after anesthesia were recorded. The mean arterial pressure and heart rate were recorded when entering the resuscitation chamber and leaving the resuscitation chamber. The VAS scores and complications of headache, nausea and vomiting, urinary retention, and pain at puncture site were observed 24 hours, 48 hours and 72 hours after operation. After the operation, a special person was sent to investigate the quantitative score of anesthetic satisfaction. Results: in terms of time, the waiting time before anesthesia, the time of drinking ban and fasting after operation in the compound anesthesia group were less than those in the spinal anesthesia group, while the time of using the resuscitation room and the operating time of the operation were less than those in the spinal anesthesia group. Sensory block time and motor block time were longer than that of spinal anesthesia group, the difference was statistically significant. In the heart rate comparison, the heart rate of the compound anesthesia group was lower than that of the spinal anesthesia group at 5 min after anesthesia, 10min after anesthesia and 15min after anesthesia, and the difference was statistically significant. In the comparison of blood pressure, the blood pressure in the combined anesthesia group was lower than that in the spinal anesthesia group immediately after anesthesia, 5min after anesthesia and 15min after anesthesia, and the difference was statistically significant. The VAS scores in the combined anesthesia group were lower than those in the spinal anesthesia group at 24 hours, 48 hours and 72 hours after operation. The score of anesthesia satisfaction in compound anesthesia group was significantly higher than that in spinal anesthesia group. Conclusion: compound anesthesia can improve postoperative analgesia effect, prolong postoperative analgesia time, shorten time of fasting and drink ban, and improve patients' satisfaction. Ultrasound-guided general anesthesia of femoral nerve block and sciatic nerve block combined with autonomic respiration has a wide application prospect in ankle surgery. Because the learning cycle is longer and the degree of mastering is more difficult than that of spinal anesthesia, it poses a new challenge to orthopedic anesthesiologists.
【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614.27

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