右美托咪定联合超声引导股神经与股外侧皮神经阻滞在髌骨骨折内固定取出术中的应用*

Application of dexmedetomidine combined with ultrasound-guided femoral nerve and lateral femoral cutaneous nerve block in surgery for removal of internal fixation after patellar fracture*

摘要:

目的 探讨右美托咪定联合超声引导股神经与股外侧皮神经阻滞在髌骨骨折内固定取出术中的临床应用价值。方法 选取2017年1月—2018年9月长沙市中心医院实施髌骨骨折内固定取出术的患者40例。随机分为超声下股神经、股外侧皮神经阻滞组（A组）、右美托咪定镇静联合超声下股神经、股外侧皮神经阻滞组（B组）。观察记录两组患者麻醉前（T0）、麻醉穿刺时（T1）、麻醉后10 min（T2）、麻醉后20?min（T3）、手术开始切皮（T4）、手术结束后（T5）各个时间点的心率（HR）、平均血压（MBP）、血氧饱和度（SpO2）；观察两组患者T1、T4、T5疼痛视觉模拟评分（VAS）；观察两组患者T0、T1、T4、T5的焦虑自评量表（SAS）评分，同时观察两组患者的不良反应如穿刺部位血肿及麻醉效果。结果 ①两组不同时间点的HR、MBP有差异（P?<0.05）；两组的HR、MBP有差异（P?<0.05）；两组的HR、MBP变化趋势有差异（P?<0.05）。②两组不同时间点的SpO2无差异（P?>0.05）；两组的SpO2无差异（P?>0.05）；两组的SpO2变化趋势无差异（P?> 0.05）。③两组不同时间点的VAS、SAS评分有差异（P?<0.05）；两组的VAS、SAS评分有差异（P?<0.05）；两组的VAS、SAS评分变化趋势有差异（P?<0.05）。两组所有患者麻醉穿刺部位无血肿形成，均无麻醉失败而导致麻醉方式的改变。结论 在髌骨骨折内固定取出手术中，右美托咪定联合超声下股神经、股外侧皮神经阻滞可有效减少焦虑，并发症少，是一种行之有效的麻醉方法。

Abstract:

Objective To explore the clinical application value of dexmedepirin combined with ultrasound-guided femoral nerve and lateral femoral cutaneous nerve block in surgery for removal of internal fixation after patellar fracture. Methods A total of 40 cases with patellar fracture internal fixation from January 2017 to September 2018 in Changsha Central Hospital were randomly divided into two groups. Group A were anesthetized by ultrasound-guided femoral nerve and lateral femoral cutaneous nerve block, and group B were anesthetized by dexmedetomidine combined with ultrasound and femoral nerve and femoral cutaneous nerve block. The heart rate (HR), mean pressure (MBP), blood oxygen saturation (SpO2) were observed and recorded before anesthesia (T0), during anesthesia puncture (T1), 10 minutes after anesthesia (T2), 20 minutes after anesthesia (T3), at the beginning of surgery (T4), and at the end of surgery (T5); the visual analogue score (VAS) of t1-t5 pain in the two groups were observed; the T0, T1, t in the two groups were observed 4. At the same time, adverse reactions such as hematoma at puncture site and anesthesia effect were observed. Results ① HR and MBP of the two groups at different time points were different (P? 0.05); there was no difference in SpO2 between the two groups (P?>?0.05); there was no difference in SpO2 change trend between the two groups (P?>?0.05). ③ There were differences in VAS and SAS scores between the two groups at different time points (P?