七氟醚预处理对全膝关节置换术患者早期康复的影响  

Effect of sevoflurane preconditioning on early recovery in patients undergoing total knee arthroplasty

作　　者：张海龙[1] 赵丽琴[2] 李民[1] 胡国东[3] 

机构地区：[1]首都医科大学附属北京潞河医院麻醉科,北京市101100 [2]首都医科大学附属北京地坛医院麻醉科 [3]首都医科大学附属北京潞河医院关节骨科,北京市101100

出　　处：《临床麻醉学杂志》2015年第9期862-865,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价七氟醚预处理对全膝关节置换术(TKA)患者早期康复的影响。方法择期全麻下拟行初次单侧TKA患者30例,随机均分为七氟醚预处理组(S组)和对照组(C组)。S组在止血带充气前吸入1 MAC七氟醚30min,而C组患者只吸入纯氧。记录两组患者术后6h、1、3、5、7和14dVAS疼痛评分。测量术前、术后1、3、7及14d患肢小腿肿胀程度(腓肠肌周径)、膝关节周径(髌骨上极)及股四头肌肿胀程度(髌骨上缘近侧4横指处),分别计算术前与术后周径的增加率。记录两组患者术后1、3、7、14d直腿抬高度数及两组患者术后3、7、14、30d关节自主活动度。结果 C组患者术后1、3、7及14d小腿肿胀程度、膝关节周径及股四头肌肿胀增加率均明显大于S组(P<0.05);C组患者术后6h、1、3、5、7dVAS疼痛评分明显高于S组(P<0.05);S组患者术后1、3、7、14d直腿抬高度数明显高于C组(P<0.05);S组患者术后3、7、14及30d膝关节自主活动度均高于C组(P<0.05)。结论七氟醚预处理可减轻TKA手术患者止血带诱发下肢缺血-再灌注损伤,可显著提高患者早期康复质量。Objective To investigate the effects of sevoflurane preconditioning on early recover- y in patients undergoing total knee arthroplasty. Methods Thirty patients who were performed first time TKA on unilateral knee were randomly divided into 2 groups （n= 15 each） ：control group （group C） and sevoflurane preconditioning group （group S）. Group S inhaled sevoflurane with the end-tidal concentration corresponding to 1MAC for 30 min before use using of tourniquet, while in group C, the patients only inhaled 100%O2. Severity of postoperative swelling, pain scores by visual analogue scale （VAS） ,range of motion and muscle strength were recorded and compared between the 2 groups. Results Swellings of the calf, the knee and the quadriceps at 1,3,7 and 14 d after surgery were all significantly more severe in group C than in group S （P〈0. 05）. The VAS pain scores at 6 h, 1,3,5, 7 d were significantly higher in group C than in group S （P〈0. 05）, but there was no significant difference in the VAS pain score at 14 d between the 2 groups. Group S had a significantly greater range of spontaneous activity of the knee at 3,7,14 d and 1 month after surgery than group C （P〈 0.05） ; Straight leg raising at 1,3,7,14 d was also significantly better in group S than in group C （P〈 0. 05）. Conclusion Sevoflurane preconditioning can reduce a tourniquet-induced lower extremity is- chemia-reperfusion injury and improve the early recovery quality in patients undergoing total knee arthroplasty.

关 键 词：七氟醚 缺血预处理 止血带 膝关节成形术 置换 

分 类 号：R614[医药卫生—麻醉学]