四种麻醉方法对全膝关节置换术患者的影响  

The influence of four anesthesia methods on patients with total knee arthroplasty

作　　者：高芳[1] 解凤磊 刘伟[1] 李梦华 Gao Fang;Xie Feng-lei;Liu Wei;Li Meng-hua(Department of Anesthesiology,Bozhou People's Hospital,Bozhou 236000,China)

机构地区：[1]亳州市人民医院麻醉科,亳州236800

出　　处：《湖南师范大学学报（医学版）》2021年第3期237-240,共4页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的:探究股神经阻滞+全麻+鸡尾酒疗法、隐神经阻滞+全麻+鸡尾酒疗法、腰麻+鸡尾酒疗法以及全身麻醉+鸡尾酒疗法对全膝关节置换术(TKA)患者的影响,为患者临床治疗提供参考。方法:回顾性分析我院2017年12月~2019年12月行全膝关节置换术治疗的80例患者临床治疗情况。按照麻醉方式的不同将其均分为4组,其中股神经阻滞+全麻+鸡尾酒疗法为A组(20例),隐神经阻滞+全麻+鸡尾酒疗法为B组(20例),腰麻+鸡尾酒疗法为C组(20例),全身麻醉+鸡尾酒疗法为D组(20例),分析患者术后膝关节评分(KSS)、视觉模拟自评量表评分(VAS)、各项手术指标、首次下地时间、首次行走距离、住院时间以及不良反应发生情况。结果:A组、B组和C组患者术后KSS评分明显高于D组,VAS评分明显低于D组,差异有统计学意义;四组患者经过治疗后显示,手术时间、术中出血量、术中输液量无明显差别,差异无统计学意义,详见表2;A组和D组患者首次下地时间和住院时间明显长于B组和C组,首次行走距离明显短于B组和C组,差异有统计学意义;A组患者治疗后并发症发生率为30.0%,D组患者治疗后并发症发生率为40.0%,明显高于B组(5.0%)和C组(10.0%),差异有统计学意义。结论:四组患者TKA术后膝关节功能和疼痛感与术前相比均得到了显著改善,而全麻+股神经阻滞+鸡尾酒疗法、全麻+隐神经阻滞+鸡尾酒疗法及腰麻+鸡尾酒疗法早期镇痛效果优于全身麻醉+鸡尾酒疗法。股神经阻滞易引起股四头肌麻痹,腰麻常引起尿潴留。隐神经阻滞镇痛效果好,不良反应少,是TKA术后较为理想的镇痛方法。Objective To evaluate the thyroid hormone level and personality characteristics of vagrant patients with impulse behavior,and to provide reference for the rescue and management of vagrant patients.To explore the effects of femoral nerve block+general anesthesia+cocktail therapy,saphenous nerve block+general anesthesia+cocktail therapy,lumbar anesthesia+cocktail therapy and general anesthesia+cocktail therapy on patients with total knee arthroplasty(TKA),so as to provide reference for clinical treatment of patients.Methods The clinical treatment of 80 patients who underwent total knee arthroplasty from December 2017 to December 2019 in our hospital was analyzed retrospectively.The patients were divided into four groups according to the different anesthesia methods:group A(20 cases),group B(20 cases),group C(20 cases),group D(20 cases),and group B(20 cases),group C(20 cases),group D(20 cases)respectively.The knee joint score(KSS)and visual analogue self rating scale(VAS)were analyzed,operation indexes,first landing time,first walking distance,hospitalization time and adverse reactions.Results The postoperative KSS scores of patients in groups A,B and C were significantly higher than that of group D,and the VAS scores were significantly lower than that of group D,the difference was statistically significant;There was no significant difference in the amount of intermediate bleeding and intraoperative infusion volume,and the difference was not statistically significant,as shown in Table 2;the patients in Group A and Group D were significantly longer in the first time to go to the ground and stayed in hospital than Group B and Group C,walking for the first time The distance was significantly shorter than that in groups B and C,the difference was statistically significant;the incidence of complications after treatment in group A was 30.0%,and the incidence of complications after treatment in group D was 40.0%,significantly higher than The difference between group B(5.0%)and group C(10.0%)was statistically significant.Co

关 键 词：股神经阻滞 隐神经阻滞 腰麻 全身麻醉 鸡尾酒疗法 全膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]