老年膝关节置换术后超声引导下的两种神经阻滞镇痛效果比较  

Effect comparison between ultrasound-guided fascia iliaca compartment nerve block and adductor canal block in analgesia for elderly patients after knee joint surgery

作　　者：王福朝[1] 孙学飞[1] 张同军[1] 王忠义[1] 齐文辉 Fu-chao Wang;Xue-fei Sun;Tong-jun Zhang;Zhong-yi Wang;Wen-hui Qi(Department of Anesthesiology,Harrison International Peace Hospital,Hengshui,Hebei 053000,Chin)

机构地区：[1]河北医科大学附属衡水市哈励逊国际和平医院麻醉科,河北衡水053000

出　　处：《中国现代医学杂志》2018年第18期103-107,共5页China Journal of Modern Medicine

摘　　要：目的比较超声引导下髂筋膜间隙神经阻滞(FICNB)与收肌管阻滞(ACB)用于老年膝关节置换术(EKR)后的镇痛效果。方法按随机数字表法将拟行全身麻醉下膝关节置换术的120例老年患者分为A组和B组,每组各60例。两组均于术前30 min给予神经阻滞干预,A组于超声引导下行FICNB,B组则行ACB。比较两组不同时间、不同区域感觉阻滞有效率、术后不同时间的静息和运动状态下视觉模拟评分(VAS)及股四头肌肌力和不良反应情况。结果两组股神经阻滞后有效率比较,差异无统计学意义(P>0.05);A组股外侧皮神经、闭孔神经阻滞有效率均高于B组(P<0.05);A组术后静息和运动状态下的VAS评分均低于B组(P<0.05);A组术后24 h股四头肌肌力小于B组(P<0.05);两组术后48 h股四头肌肌力、药物不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下髂FICNB相比ACB用于EKR后镇痛效果更佳,前者术后24 h对股四头肌肌力影响相对大,但术后48 h影响减小,建议根据情况选择合适神经阻滞方式。Objective To compare the analgesic effect of ultrasound-guided fascia iliaca compartment nerve block（FICNB） and adductor canal block（ACB） in analgesia for elderly patients after knee replacement. Methods A total of 120 elderly patients undergoing knee replacement under general anesthesia were randomly divided into group A and group B with 60 cases in each group. Both group were given nerve block intervention 30 min before surgery. Group A were given ultrasound-guided FICNB while group B were given ACB. The effective rates of sensory block in different regions, resting and active visual analogue scores（VAS）, muscle strength of quadriceps femoris and adverse reactions were compared between the two groups. Results The effective rates of lateral femoral cutaneous nerve and obturator nerve sensory block in group A 10 min, 20 min and 30 min after nerve block were significantly higher than those in group B（P 〈 0.05）. The resting and active VAS scores of group A 2 h, 6 h, 12 h, 24 h and 48 h after surgery were significantly lower than those of group B（P 〈 0.05）. The muscle strength of quadriceps femoris of group A 24 h after surgery was significantly smaller than that of group B（P 〈 0.05）. There were no significant differences between the two groups in the muscle strength of quadriceps femoris and the incidence of adverse drug reactions 48 h after operation（P 〉 0.05）. Conclusion Compared with adductor canal block, the analgesic effect of ultrasound-guided FICNB is more significant in the elderly after knee replacement. Though the effect of the later on muscle strength of quadriceps femoris is relatively greater 24 h after surgery, the effect decreases 48 h after surgery, it is recommended to choose the appropriate nerve block depending on the situation.

关 键 词：老年膝关节置换术 超声引导 髂筋膜间隙神经阻滞 收肌管阻滞 

分 类 号：R614.2[医药卫生—麻醉学]