全膝关节置换术中应用连续收肌管阻滞的效果观察  

The effect of continuous adductor canal block on postoperative analgesia in patients undergoing total knee arthroplasty

作　　者：应婷婷[1] 周纲[1] 贺茹依 程英[1] 曹建斌 丛海涛[1] YING Ting-ting;ZHOU Gang;HE Ru-yi;CHENG Ying;CAO Jian-bin;CONG Hai-tao(Department of Anesthesiology,Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang 317000,Chirm)

机构地区：[1]浙江省台州医院麻醉科,浙江台州317000

出　　处：《中华全科医学》2020年第12期2032-2036,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2019RC088)。

摘　　要：目的分析利多卡因、罗哌卡因联合舒芬太尼连续收肌管阻滞在全膝关节置换术后的镇痛效果,为临床上全膝关节置换术后镇痛提供参考。方法选取2016年1月—2019年1月浙江省台州医院择期行全膝关节置换术的患者100例,按照随机数字表法分为股神经阻滞组和收肌管阻滞组,各50例。对比2组不同时间点疼痛情况、膝关节活动度等指标。结果收肌管阻滞组治疗后24、48、72 h静息痛评分为(1.37±0.18)分、(0.97±0.10)分、(0.72±0.10)分,低于股神经阻滞组[(1.58±0.20)分、(1.12±0.24)分、(0.98±0.16)分],差异有统计学意义(t=5.519、4.079、9.744,均P<0.001);收肌管阻滞组治疗后24、48、72 h活动痛评分为(2.29±0.05)分、(2.03±0.18)分、(1.67±0.25)分,均低于股神经阻滞组[(3.28±0.26)分、(2.54±0.34)分、(2.00±0.15)分],差异有统计学意义(t=26.440、9.374、8.004,均P<0.001)。收肌管阻滞组治疗后24、48、72 h膝关节活动度为(83.84±3.67)°、(100.76±6.05)°、(113.51±6.53)°,均高于股神经阻滞组[(75.47±2.84)°、(91.74±3.87)°、(105.67±3.79)°],差异有统计学意义(t=12.750、8.881、7.333,均P<0.001)。结论全膝关节置换术中应用利多卡因、罗哌卡因、舒芬太尼连续收肌管阻滞,可缓解术后疼痛,镇痛效果较好。Objective To analyze the analgesic effect of continuous adductor canal block with lidocaine,ropivacaine and sufentanil in patients undergoing total knee arthroplasty,so as to provide a reference for clinical analgesia after total knee arthroplasty.Methods From January 2016 to January 2019,100 patients who underwent total knee arthroplasty in Taizhou Hospital of Zhejiang Province were randomly divided into two groups according to the random number table method:femoral nerve block group(50 cases)and adductor canal block group(50 cases).The pain,knee joint range of motion and other indicators were compared between the two groups at different time points.Results The scores of resting pain at 24,48 and 72 hours after treatment in adductor canal block group were(1.37±0.18),(0.97±0.10),(0.72±0.10)points,which were lower than those of the femoral nerve block group[(1.58±0.20),(1.12±0.24),(0.98±0.16)points],the difference was statistically significant(t=5.519,4.079,9.744,all P<0.001).The activity pain scores of the adductor canal block group were(2.29±0.05),(2.03±0.18),(1.67±0.25)points at 24,48,and 72 h after treatment,all of which were lower than the femoral nerve block group[(3.28±0.26),(2.54±0.34),and(2.00±0.15)points],with statistically significant differences(t=26.440,9.374,8.004,all P<0.001).knee joint range of motion in adductor canal block group was(83.84±3.67)°,(100.76±6.05)°and(113.51±6.53)°at 24,48 and 72 hours after treatment,which were higher than those in femoral nerve block group[(75.47±2.84)°,(91.74±3.87)°and(105.67±3.79)°],the difference was statistically significant(t=12.750,8.881 and 7.333,all P<0.001).Conclusion Continuous adductor canal block with lidocaine,ropivacaine and sufentanil in total knee replacement can relieve postoperative pain with good analgesic effect.

关 键 词：关节炎 利多卡因 罗哌卡因 舒芬太尼 连续收肌管阻滞 全膝关节置换术 镇痛 

分 类 号：R614.1[医药卫生—麻醉学] R687.4[医药卫生—外科学]