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| 股神经阻滞对七氟醚抑制膝关节镜置入时肾上腺素能反应的最低肺泡有效浓度的影响 |
| Effect of femoral nerve block on the MACBAR of sevoflurane in patients undergoing knee arthroscopy surgery |
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| DOI：10.12089/jca.2021.07.006 |
| 中文关键词: 七氟醚 最低肺泡有效浓度 股神经阻滞 膝关节镜 儿茶酚胺 |
| 英文关键词: Sevoflurane Minimum alveolar concentration Femoral nerve block Knee arthroscopy Catecholamine |
| 基金项目:南充市科知局项目（18SXHZ0161）；四川省科技厅苗子工程项目（2020JDRC0107） |
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| 中文摘要: |
目的 探讨超声引导下股神经阻滞对膝关节镜手术患者膝关节镜置入时七氟醚抑制肾上腺素能反应的最低肺泡有效浓度（MACBAR）的影响。
方法 选择2019年5—8月拟行择期单侧膝关节镜手术患者36例，男19例，女17例，年龄18～64岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：阻滞组和对照组。阻滞组全麻诱导前于超声引导下行患侧股神经阻滞，采用针刺法评估VAS疼痛评分判断阻滞效果；对照组仅行全麻。两组全麻方法相同。采用序贯法测定七氟醚MACBAR。采用ELISA法测定膝关节镜置入前3 min、置入后3 min血浆肾上腺素及去甲肾上腺素浓度。记录拔管时间、拔管时VAS疼痛评分。
结果 阻滞组和对照组的MACBAR分别为2.73%（95%CI 2.65%～2.82%）和3.50%（95%CI 3.32%～3.68%）。与对照组比较，阻滞组七氟醚MACBAR明显降低（P＜0.05），拔管时间明显缩短（P＜0.05），VAS疼痛评分明显降低（P＜0.05）。阻滞组膝关节镜置入后血浆肾上腺素和去甲肾上腺素浓度分别为（784.82±348.52）pg/ml和（882.76±430.50）pg/ml，对照组膝关节镜置入后血浆肾上腺素和去甲肾上腺素浓度分别为（721.84±314.32）pg/ml和（806.69±467.88）pg/ml，两组差异无统计学意义。
结论 超声引导下股神经阻滞可明显降低膝关节镜手术患者膝关节镜置入时七氟醚MACBAR，缩短拔管时间，有利于术后镇痛。当50%患者肾上腺素能反应被抑制时，血浆肾上腺素和去甲肾上腺素浓度变化不受股神经阻滞的影响。 |
| 英文摘要: |
Objective To observe the effect of femoral nerve block guided by ultrasound on the minimum alveolar concentration of sevoflurane for blocking adrenergic response (MACBAR) in patients undergoing knee arthroscopy.
Methods Thirty-six patients undergoing unilateral knee arthroscopy from May to August 2019, 19 males and 17 females, aged 18-64 years, ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into two groups: block group and control group. The block group was guided by ultrasound and evaulate the effect by using VAS scores. The two groups experienced the same general anesthesia. The sequential allocation technique was applied to determine the MACBAR of sevoflurane. The plasma epinephrine and norepinephrine concentrations were also determined 3 min before and after the knee arthroscope insertion by ELISA. The extubation time and the VAS score after extubation were evaluated.
Results The MACBAR of sevoflurane in the block group and the control group were 2.73% (95% CI 2.65%-2.82%) and 3.50% (95% CI 3.32%-3.68%), respectively. The MACBAR, the extubation time and VAS score in the block group were significantly lower than those in the control group (P < 0.05). After knee arthroscope insertion, the plasma epinephrine and norepinephrine concentrations were (784.82 ± 348.52) pg/ml and (882.76 ± 430.50) pg/ml in the block group, and (721.84 ± 314.32) pg/ml and (806.69 ± 467.88) pg/ml in the control group, respectively. No significant differences were found in the concentrations of epinephrine and norepinephrine between before and after knee arthroscope insertion between the two groups.
Conclusion Ultrasound-guided femoral nerve block can effectively decrease the MACBAR of sevoflurane in patients undergoing knee arthroscopic surgery, shorten the extubation time, and benefit to postoperative analgesia. When the sympathetic adrenergic response of half patients is inhibited, the changes of plasma epinephrine and norepinephrine concentrations are not affected by the block of femoral nerve. |
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