收肌管阻滞联合膝关节周围局部浸润麻醉对全膝关节置换术病人术后炎症反应的影响  

Effect of adductor canal block and local infiltration anesthesia around knee joint on inflammatory responses in patients undergoing total knee arthroplasty

作　　者：王春光[1] 张志强[2] 马文海[3] 贾文文[4] 郝迁 刘蕊 韩宝君[3] 李永旺[3] 汤世宇 Wang Chunguang;Zhang Zhiqiang;Ma Wenhai;Jia Wenwen;Hao Qian;Liu Rui;Han Baojun;Li Yongwang;Tang Shiyu(Department of Anesthesiology,the First Center Hospital of Baoding,Baoding 071000,China;Department of Cardio-Thoracic Surgery,the First Center Hospital of Baoding,Baoding 071000,China;Department of Orthopedics,the First Center Hospital of Baoding,Baoding 071000,China;Department of Laboratory Medicine,the First Center Hospital of Baoding,Baoding 071000,China;Graduate School of Chengde Medical University,Chengde 067000,China)

机构地区：[1]保定市第一中心医院麻醉科,071000 [2]保定市第一中心医院心胸外科,071000 [3]保定市第一中心医院骨科,071000 [4]保定市第一中心医院检验医学科,071000 [5]承德医学院研究生院,067000

出　　处：《中华麻醉学杂志》2020年第7期783-786,共4页Chinese Journal of Anesthesiology

基　　金：河北省医学科学研究课题计划项目(20191236)。

摘　　要：目的评价收肌管阻滞联合膝关节周围局部浸润麻醉对全膝关节置换术病人术后炎症反应的影响。方法择期行全膝关节置换术病人60例,年龄54~76岁,性别不限,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=30):收肌管阻滞组(A组)和收肌管阻滞联合膝关节周围局部浸润麻醉组(AL组)。2组气管插管完成后,采用0.5%罗哌卡因15 ml行收肌管阻滞;AL组在术中截骨完成后由术者行膝关节周围局部浸润麻醉。术毕行病人自控收肌管阻滞镇痛,配方:罗哌卡因400 mg,用0.9%氯化钠注射液稀释到200 ml,背景输注速率5 ml/h,PCA剂量5 ml,锁定时间30 min。VAS评分>4分时,按压镇痛泵后30 min仍未缓解,则肌肉注射盐酸哌替啶100 mg进行镇痛补救。分别于麻醉诱导前即刻(T0)、术后24、48和72 h(T1-3)采集外周静脉血标本,采用ELISA法检测血清IL-6和IL-10的浓度。分别于T1-3时评定患肢肌力;记录术后72 h内病人满意度评分、镇痛补救情况及不良反应发生情况。结果与A组比较,AL组术后各时点血清IL-6浓度降低,血清IL-10浓度升高,术后病人满意度评分增加,镇痛补救率降低(P<0.05),术后患肢股四头肌肌力和不良反应发生率差异无统计学意义(P>0.05)。结论收肌管阻滞联合膝关节周围局部浸润麻醉可减轻全膝关节置换术病人术后炎症反应。Objective To evaluate the effect of adductor canal block(ACB)and local infiltration anesthesia(LIA)around the knee joint on inflammatory responses in the patients undergoing total knee arthroplasty(TKA).Methods Sixty American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes,aged 54-76 yr,scheduled for elective TKA,were divided into 2 groups(n=30 each)using a random number table method:ACB group(group A)and ACB combined with LIA around knee joint group(group AL).ACB was performed with 0.5%ropivacaine 15 ml after endotracheal intubation in group A and group AL,and in addition LIA was performed around the knee joint after the osteotomy was completed during surgery in group AL.The patient-controlled ACB analgesia was applied at the end of surgery in both groups.The analgesic solution contained ropivacaine 400 ml(in 0.9%normal saline 200 ml),and the analgesic pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 5 ml/h.When visual analog scale score>4,and pain was still not relived at 30 min after pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.Peripheral venous blood samples were collected immediately before surgery(T0)and at 24,48 and 72 h after surgery(T1-3)for determination of serum interleukin-6(IL-6)and IL-10 concentrations by enzyme-linked immunosorbent assay.The muscle strength on the affected side was assessed at T1-3.The patients′satisfaction score,requirement for rescue analgesia,and adverse effects were recorded.Results Compare with group A,the serum IL-6 concentrations were significantly decreased and serum IL-10 concentrations were increased at each time point after surgery,postoperative patients′satisfaction scores were increased,the requirement for rescue analgesia was decreased(P<0.05),and no significant change was found in the quadriceps strength of the affected limb and incidence of adverse reactions after surgery in group AL(P>0.05).Conclusion ACB and LIA around the kn

关 键 词：局部浸润麻醉 术后炎症反应 收肌管阻滞 盐酸哌替啶 全膝关节置换术 输注速率 患肢肌力 麻醉诱导 

分 类 号：R614[医药卫生—麻醉学]