超声引导下收肌管联合IPACK阻滞对TKA手术患者麻醉效果及预后的影响观察  

Effect of Ultrasound-guided Adductor Canal Combined with IPACK Block on Anesthetic Effect and Prognosis of Patients Undergoing TKA

作　　者：刘宇权 陈燕中 曾志文[1] 廖亿粦[1] 王伟昌 LIU Yuquan;CHEN Yanzhong;ZENG Zhiwen;LIAO Yilin;WANG Weichang(Meizhou People’s Hospital,Meizhou 514031,China;不详)

机构地区：[1]广东省梅州市人民医院,广东梅州514031

出　　处：《中国医学创新》2020年第24期66-70,共5页Medical Innovation of China

基　　金：梅州市社会发展科技计划项目(2018B017)。

摘　　要：目的:观察超声引导下收肌管联合腘动脉与膝关节后囊间隙(IPACK)阻滞对全膝关节置换(TKA)手术患者的麻醉效果及对预后的影响。方法:选取2018年2月-2019年12月本院收治的择期TKA患者60例,按照患者自愿及非随机对照原则分为两组,对照组(n=32)采用收肌管阻滞麻醉,观察组(n=28)采用收肌管联合IPACK阻滞麻醉。采用麻醉/脑电意识监测系统(Narcotrend)监测两组麻醉深度,记录两组术后各临床指标,比较两组术后运动阻滞改良Bromage评分、术后不良反应发生率、疼痛情况(VAS)。结果:观察组各时间点Narcotrend数值均低于对照组(P<0.05),麻醉药物用量显著少于对照组(P<0.05);观察组术后自主呼吸恢复时间、苏醒时间、拔管时间、术后首次下床行走时间、瑞芬太尼用量、镇痛泵有效按压次数、不良反应发生率均少于对照组(P<0.05);观察组术后48 h内VAS评分均低于对照组(P<0.05);观察组术后24 h内Bromage评分均高于对照组(P<0.05)。结论:超声引导下收肌管联合IPACK阻滞能有效降低TKA手术过程中的疼痛等应激反应,减少维持麻醉药物用量,显著提高麻醉质量与麻醉恢复速度,术后具有良好的镇静效果,不良事件发生率更低。Objective:To observe the effect of ultrasound-guided adductor canal combined with infiltration between the popliteal artery and capsule of knee(IPACK)block on the anesthetic effect and prognosis of patients undergoing total knee arthroplasty(TKA).Method:A total of 60 patients who underwent elective TKA in our hospital from February 2018 to December 2019 were selected and divided into two groups according to the voluntary and non-randomized control principle.The control group(n=32)was given adductor canal block anesthesia,and the observation group(n=28)was given adductor canal combined with IPACK block anesthesia.Narcotrend was used to monitor the depth of anesthesia in two groups.The postoperative clinical data of two groups were recorded.The postoperative motor block modified Bromage scores,incidence rates of postoperative adverse reactions and pain(VAS)scores of two groups were compared.Result:The Narcotrend levels in the observation group at each time point were lower than those in the control group(P<0.05),and the application amount of anesthetics used was significantly lower than that in the control group(P<0.05).The postoperative spontaneous respiration recovery time,awakening time,extubation time,postoperative ambulation time,the application amount of remifentanil,the number of effective analgesic pump compressions and the incidence of adverse reactions in the observation group were shorter/lower than those in the control group(P<0.05).The VAS score of the observation group within 48 h after operation were lower than those of the control group(P<0.05).The Bromage score of the observation group within 24 h after operation were higher than those of the control group(P<0.05).Conclusion:The ultrasound-guided adductor canal combined with IPACK block can effectively reduce the pain and other stress reactions during TKA,reduce the application amount of maintenance anesthetics,and significantly improve the quality of anesthesia and the speed of anesthesia recovery,with excellent sedative effect and lower incidence

关 键 词：超声引导 收肌管 腘动脉与膝关节后囊间隙 神经阻滞 麻醉效果 

分 类 号：R614[医药卫生—麻醉学]