超声引导下单次收肌管阻滞在老年全膝关节置换围手术期镇痛的应用  

Application of ultrasound-guided single-injection adductor canal block for perioperative pain control in elderly patients underwent total knee arthroplasty

作　　者：马立峰[1] 李超[2] 郭艾[1] 曾娜[3] 杨波[1] 刁乃成[1] 王芳[2] 张京新 齐峥嵘 李智尧 MA Li-feng;LI Chao;GUO Ai(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050 [2]首都医科大学附属北京友谊医院麻醉科,北京100050 [3]首都医科大学附属北京友谊医院消化系统疾病临床研究中心方法学平台,北京100050

出　　处：《临床和实验医学杂志》2020年第15期1661-1665,共5页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学附属北京友谊医院科研启动基金项目(编号:yyqdkt2018-7)。

摘　　要：目的探讨超声引导下单次收肌管阻滞在老年全膝关节置换围手术期镇痛的应用效果。方法采用前瞻性研究方法,选取2019年1~11月在首都医科大学附属北京友谊医院接受单侧全膝关节置换术的老年患者68例,按照随机数字表法将其分为观察组和对照组,每组各34例。观察组患者在超声引导下单次收肌管阻滞进行膝关节置换围手术期镇痛,对照组患者在超声引导下单次股神经阻滞进行围手术期镇痛。记录并比较两组患者术后12 h、24 h、48 h静态疼痛和动态疼痛程度的视觉模拟评分(VAS)。记录并比较两组患者术前、术后第1天、第3天和1周膝关节活动度和股四头肌肌力。当VAS>7分时口服50 mg盐酸曲马多进行补救镇痛治疗,记录两组术后补救镇痛治疗的患者数量和镇痛药物的不良反应情况。结果观察组术后12 h、24 h和48 h静息VAS为6.5±0.9分、5.8±0.7分和4.2±0.5分,动态VAS为7.1±0.9分、5.9±0.8分和4.5±0.6分;而对照组静息VAS为6.4±0.8分、5.6±0.6分和4.1±0.5分,动态VAS为7.2±0.8分、5.8±0.7分和4.4±0.5分。两组术后各时间点静息VAS和动态VAS比较,差异无统计学意义(P>0.05)。观察组患者膝关节活动度优于对照组,两组差异具有统计学意义(P<0.05);观察组患者股四头肌肌力好于对照组,两组比较差异具有统计学意义(P<0.05)。两组患者使用盐酸曲马多数量和镇痛药物不良反应比较,差异无统计学意义(P>0.05)。结论超声引导下单次收肌管阻滞在老年全膝关节置换围手术期镇痛效果满意。该神经阻滞方法对股四头肌肌力没有影响,有利于老年患者全膝关节置换术后康复。Objective To investigate the efficacy of ultrasound-guided single-injection adductor canal block for perioperative pain control in elderly patients underwent total knee arthroplasty.Methods A prospective study was performed on 68 elderly patients who were underwent single total knee arthroplasty in Beijing Friendship Hospital,Capital Medical University from January to November 2019.They were divided into two groups randomly: the observation group and thecontrol group,34 cases in each group.Patients in the observation group underwent ultrasound-guided single-injection adductor canal block for perioperative pain control,while patients in the control group underwent ultrasound-guided single-injection femoral nerve block for perioperative pain control.At 12 h,24 h and 48 h after operation,visual analogue scale(VAS) were recorded of all the patients at rest and during activity,and then the difference of the two groups were compared.At one day,three days,seven days after operation,the range of knee movement and the strength of quadriceps were recorded and compared between the two groups.If VAS >7,50 mg Tramadol hydrochloride was used orally for rescue analgesic.The number of patients who need rescue analgesic and the adverse reactions of analgesic drugs were recorded.Results In the observation group,VAS at rest were 6.5 ± 0.9,5.8 ± 0.7,4.2 ± 0.5,and VAS during activity were 7.1 ± 0.9,5.9 ± 0.8,4.5 ± 0.6 respectively at 12 h,24 h and 48 h after operation.In the control group,VAS at rest were 6.4 ± 0.8,5.6 ± 0.6,4.1 ± 0.5,and VAS during activity were 7.2 ± 0.8,5.8 ± 0.7,4.4 ± 0.5 at above time points.There was no statistically significant difference for VAS at rest and during activity between the two groups(P >0.05).For the range of knee movement,the results of the observation group were much better than the results of the control group and the differences were statistically significant(P< 0.05).The quadriceps strength of the observation group was better than that of the control group and the difference was s

关 键 词：膝关节置换 超声引导 神经阻滞 收肌管 围手术期镇痛 快速康复 

分 类 号：R614[医药卫生—麻醉学]