| Objective The ultrasound guidance can be blood vessels,nerves and organs of the body in the way of image fully reflected,provide a reliable basis for accurate positioning,thereby minimizing the risk and difficulty of elderly patients during anesthesia and nerve block management.Objective to evaluate the efficacy and safety of ultrasound guided techniques in elderly anesthesia for inguinal surgery in the elderly.Methods October 2014-December 2015 to our hospital for treatment of groin surgery in 60 cases of elderly patients were selected as the research object,all patients were treated by surgical treatment of unilateral inguinal told patients before anesthesia,forbidden to drink for 2 hours,8 hours of fasting,preoperative 0.5h for patients with intramuscular injection of 50 g/kg midazolam.After entering the operation room,the non-invasive blood pressure,electrocardiogram and pulse oxygen saturation were observed strictly.They were randomly divided into control group and study group two groups,each group had 30 cases,control group with general anesthesia,using sufentanil(Yichang humanwell pharmaceutical limited liability company(g/kg+ 0.3?1.0)propofol AstraZeneca)2?3mg/kg+ cisatracurium(Zhejiang Xianju pharmaceutical Limited by Share Ltd)0.5?0.6mg/kg for induction of anesthesia,patient consciousness after the disappearance of LMA,with propofol in the operation(AstraZeneca)3?6mg/(kg.h)+ remifentanil(Yichang humanwell Pharmaceutical Co.,Ltd)0.2?0.3 g/(kg.h)to maintain anesthesia;the study group took ultrasound guided nerve block,which is in the vein after the opening,in the implementation of iliac abdominal ultrasound guided with iliac inguinal nerve block,to draw a small dose of sufentanil before skin(Yichang humanwell Pharmaceutical Co.,Ltd)0.1-0.3 g/kg,continuous infusion of small doses of dextromethorphan in operation Support the mi(Jiangsu Hengrui pharmaceutical Limited by Share Ltd)0.2-0.7 g/(kg.h).Records of all patients entered the operation room(T1),before skin incision(T2),and 10min after skin incision after surgery(T4)mean arterial pressure at each time point(MAP),pulse oxygen saturation(SPO2),heart rate(HR)and respiratory rate(RR)changes,intraoperative body the dynamic and occurrence of respiratory depression;and patients with postoperative recovery time,the dosage of sufentanil,PACU observing time;at the same time were recorded and compared two groups of patients with intraoperative body movement,intraoperative respiratory depression,restlessness,postoperative adverse reaction and the occurrence rate of POCD into ICU,and take the visual analogue scale(VAS method)to evaluate patients with postoperative 30 min,1H and 4h after the pain,if the score less than 4 points,it should be for patients with intravenous infusion of 2mg/kg of tramadol,cases of tramadol injection in two groups of transmission Row record.And take the Raven to evaluate 8h and 24h before and after operation of two groups of patients with 24h after each time point of the cognitive function.A questionnaire survey was conducted to investigate and analyze the satisfaction of the two groups of patients.Results There was no significant difference between the two groups in gender,age,weight,height,intraoperative blood loss,and operation time,and they were not statistically significant(P>0.05),and could be compared.The control groups at T1 MAP and HR T2,T3 and T4 index and time points compared with the obvious difference,with statistical significance(P<0.05);group T1,T2,of T3 and T4 at different time points MAP,RR,HR and SPO2 showed no significant difference,does not have statistical significance(P>0.05 patients in the control group);T2,T3 and T4 time points MAP and HR indicators and research group,there were significant differences,with statistical significance(P<0.05).There were significant differences in PACU stay time,recovery time and intravenous anesthetic dose between the two groups,with statistical significance(P<0.05).Compared with the study group,the incidence of adverse reactions in the control group,such as intraoperative body motion,intraoperative respiratory depression,postoperative agitation,COPD and ICU,were statistically significant(P<0.05).The control test scores and patients Raven group patients before 24h after 8h there are some obvious differences,with statistical significance(P<0.05);the control group of patients after operation 8h score and raven s test after 24h also significantly different,with statistical significance(P<0.05);but the Raven test preoperative 24h score and postoperative 24h no significant difference does not have statistical significance(P>0.05).The study group patients with preoperative 24h,raven test scores at each time point 24h 8h and postoperative no difference does not have statistical significance(P>0.05).Compared with the study group,the pain scores of the control group,30min,1H and 4H at each time point were significantly different,with statistical significance(P<0.05).The satisfaction rate of the patients in the control group was 96.67%,and the satisfaction rate of the patients in the study group was 80%.There were significant differences in the satisfaction between the two groups,which were statistically significant(P<0.05).Conclusion Take the ultrasound iliohypogastric and ilioinguinal nerve block in elderly patients under treatment for inguinal surgery,the effect is much better than that of total intravenous anesthesia,which can significantly reduce the discomfort of patients with intraoperative and postoperative patients,promote the rapid recovery of cognitive function,promote patient recovery as soon as possible,and the analgesic effect is ideal at the same time,can effectively improve patient care satisfaction,which not only effective and safe,worthy of promotion in clinical use. |
PDF Full Text Request