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    杨光, 郑曼, 季方兵, 徐钢, 武茜. 超声或神经刺激仪辅助股神经阻滞用于膝关节置换术快通道麻醉的观察[J]. 徐州医科大学学报, 2017, 37(5): 308-311.
    引用本文: 杨光, 郑曼, 季方兵, 徐钢, 武茜. 超声或神经刺激仪辅助股神经阻滞用于膝关节置换术快通道麻醉的观察[J]. 徐州医科大学学报, 2017, 37(5): 308-311.
    YANG Guang, ZHENG Man, JI Fangbing, XU Gang, WU Qian. Application of ultrasound and nerve stimulators in assisting femoral nerve blockage for fast-track anesthesia in total knee arthroplasty[J]. Journal of Xuzhou Medical University, 2017, 37(5): 308-311.
    Citation: YANG Guang, ZHENG Man, JI Fangbing, XU Gang, WU Qian. Application of ultrasound and nerve stimulators in assisting femoral nerve blockage for fast-track anesthesia in total knee arthroplasty[J]. Journal of Xuzhou Medical University, 2017, 37(5): 308-311.

    超声或神经刺激仪辅助股神经阻滞用于膝关节置换术快通道麻醉的观察

    Application of ultrasound and nerve stimulators in assisting femoral nerve blockage for fast-track anesthesia in total knee arthroplasty

    • 摘要: 目的观察超声或神经刺激仪辅助股神经阻滞用于人工全膝关节置换术(TKA)的麻醉苏醒时间及镇痛效果。方法60例行TKA手术的患者随机分为3组,每组20例,各组患者均予单次股神经阻滞,Ⅰ组于麻醉前在超声引导下给予,Ⅱ组麻醉前在神经刺激仪引导下给予,Ⅲ组术毕清醒拔管后在超声引导下给予。所有患者术前静脉注射帕瑞昔布40 mg,术中膝后关节囊局麻药浸润,术后自控静脉镇痛(PCIA),舒芬太尼0.2 μg/kg,背景剂量后2 ml/h。观察术中镇痛镇静药用量、术后患者苏醒时间和对麻醉的满意度,观察股神经阻滞操作时间及阻滞起效时间,记录术后6、12、24、48 h静息时视觉模拟疼痛评分(RVAS)及相关不良反应。结果相比于Ⅲ组,Ⅰ、Ⅱ组术中镇痛镇静药用量明显减少(P<0.05)、术后苏醒时间缩短(P<0.05),Ⅰ组比Ⅲ组麻醉满意度增加(P<0.05),Ⅰ组比Ⅱ组股神经阻滞成功时间和阻滞起效时间缩短(P<0.05),3组术后RVAS及不良反应的差异无统计学意义(P>0.05)。结论术前单次股神经阻滞加静脉快通道麻醉技术可以促进TKA患者术后快速康复,与神经刺激仪比较,超声更有利于引导神经阻滞操作。

       

      Abstract: Objective To observe the effects of ultrasound and nerve stimulators in assisting femoral nerve blockage for fast-track anesthesia in total knee arthroplasty (TKA). MethodsA total of 60 patients undergoing TKA were randomly divided into three groups (n=20). All the patients performed single femoral nerve blockage. Group Ⅰ was blocked before anesthesia guided by ultrasound. Group Ⅱ was blocked by a nerve stimulator before anesthesia. Group Ⅲ was blocked after awaking guided by ultrasound. All the patients were intravenously injected with 40 mg parecoxib before operation, and exposed to local anesthetics during operation followed by patient-controlled intravenous analgesia (PCIA) after operation using 0.2 μg/kg sufentanil at a rate of 2 ml/h after background doses. Then, the doses of anesthetics used during the operation, awakening time in postanesthesia care unit (PACU) and patient satisfaction on anesthesia were observed. The time to perform femoral nerve blockage and blockage time were recorded. The rest visual analogue scores (RVAS) at 6, 12, 24 and 48 hours after operation, and adverse reactions were recorded. ResultsCompared with Group Ⅲ, the doses of anesthetics used during operation and awakening time were reduced in Groups Ⅰ and Ⅱ (P<0.05). Group Ⅰ showed improved patient satisfaction on anesthesia, compared with Group Ⅲ (P<0.05). Group I also presented shorter time to perform femoral nerve blockage and blockage time than Group Ⅱ (P<0.05). No statistical difference was found in RVAS at 6, 12 ,24 and 48 hours after operation and adverse reactions among the three groups (P>0.05). ConclusionsSingle femoral nerve blockage before operation combined with fast-track anesthesia can stimulate the recovery of TKA patients. Compared with nerve stimulators, ultrasound is more beneficial to guide the blockage.

       

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