超声引导收肌管阻滞联合膝关节后方浸润麻醉用于全膝关节置换手术的疗效观察  

The effects of ultrasound-guided adductor canal block combined with posterior infiltration anesthesia of the knee joint with total knee replacement patients

作　　者：张怀奇 李贺[1] 李琼[1] 刘纪文[1] 韩卫东[1] 任从才 ZHANG Huaiqi;LIe;LI Qiong(Department of Pain Surgery,the eight affiliated hospital,SUN YAT-SEN University,Shenzhen 518033,China)

机构地区：[1]中山大学附属第八医院疼痛科,深圳518033

出　　处：《临床外科杂志》2018年第8期613-615,共3页Journal of Clinical Surgery

基　　金：深圳市福田区卫生公益性科研资助项目(FTWS20160068)

摘　　要：目的观察超声引导下收肌管阻滞联合膝关节后方浸润麻醉应用于全膝关节置换手术的效果。方法接受全膝关节置换手术的病人30例,采用随机数字表法将30例病人分为两组,对照组15例,采用超声引导下收肌管阻滞,试验组15例,采用超声引导下收肌管阻滞联合膝关节后方浸润麻醉。比较两组病人术后不同时间点的视觉模拟评分、肢体功能(术后首次直腿抬高时间、肌四头肌肌力、关节活动度)。结果两组病人收肌管阻滞过程中的麻醉药物剂量的差异均无统计学意义(P>0.05)。两组病人术后静息状态下疼痛评分比较,第3小时、6小时、12小时、24小时VAS评分均有明显差异(P<0.05),重复测量方差分析发现,两组病人疼痛评分存在差异(P<0.05),不同时间点存在差别(P<0.05),说明病人VAS评分随时间变化的速度不一致。两组病人股四头肌肌力和关节活动度比较,差异有统计学意义(P<0.05)。术后对照组和试验组均有2例病人出现了尿潴留,无其他药物不良反应。结论超声引导下收肌管阻滞联合膝关节后方浸润麻醉与单纯收肌管阻滞比较,能更好地缓解全膝关节置换术病人预后过程中疼痛程度,且随着时间迁移病人疼痛程度均有明显下降,不同处理方式的病人疼痛程度下降速度不一致。两组病人术后的肢体功能亦存在差异,主要表现在股四头肌肌力和关节活动度两个方面。Objective To observe the effect of ultrasound-guided adductor canal block combined with posterior infiltration anesthesia of the knee joint with Ttotal knee arthroplasty（TKA） patients, neth- otis Retrospective analysis during TKA surgery in our hospital of 30 patients with surgery. Thirty patients were divided into two groups using the random number table method, and 15 cases in the control group which treated by adductor duct block under ultrasound guidance. Other 15 cases in the experimental group which treated by ultrasound-guided adductor canal block combined with posterior infiltration anesthesia of the knee joint. Comparing the VAS scores, physical functions （ the first straight leg raising time, muscle muscle strength,and joint mobility） between the two groups. Results The difference between the basic conditions of the two groups and the dose of anesthetic drugs in the process of myoduct blocking were sta- tistically significant（P 〉 0.05 ）. Under different postoperative resting state, two groups of patients with postoperative pain score, 3 hours, 6 hours, 12 hours, 24 hours of VAS scores were significantly different （ P 〈0.05 ） ,repetitive measure analysis of variance,found that quality of life there is a difference between the groups （ P 〈 0. 05 ）, and there was a difference at different time （ P 〈 0. 05 ）, the patient VAS scores did not match the speed of change over time ; The comparison of two groups of patients limb function, quad- riceps muscle（ P 〈 0.05 ） and motion（ P 〈 0.05 ） there were significant differences; Both the control group and the experimental group had two patients with urinary retention and no other adverse effects. Conclu- sion Uhrasound guided adductor tube blocking united behind the knee joint infiltration anesthesia than pure muscle tube block, better relief of pain during the process of TKA patients prognosis, and patients de- gree of pain were significantly decreased with time migration, the pain of patients with different treatments d

关 键 词：全膝关节置换术 神经传导阻滞 收肌管 股神经 镇痛 

分 类 号：R614[医药卫生—麻醉学]