单次收肌管阻滞联合患者自控静脉镇痛在全膝关节置换术术后镇痛的效果观察  

Effect of single shot adductor canal blockade combined with patient controlled intravenous analgesia in postoperative analgesia of total knee arthroplasty

作　　者：张莹[1] 王天龙[1] 符颖[2] Zhang Ying;Wang Tianlong;Fu Ying(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Disorders,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科国家老年疾病临床医学研究中心,北京100053 [2]首都医科大学宣武医院超声诊断科国家老年疾病临床医学研究中心,北京100053

出　　处：《北京医学》2021年第7期608-611,615,共5页Beijing Medical Journal

摘　　要：目的探讨单次收肌管阻滞(single shot adductor canal blockade,SACB)联合患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)和连续收肌管阻滞(continuous adductor canal blockade,CACB)在全膝关节置换术(total knee arthroplasty,TKA)术后镇痛中的效果和不良反应。方法收集2018年1月至2019年12月首都医科大学宣武医院行TKA的患者的临床资料,筛选SACB联合PCIA组(A组)46例,CACB组(B组)43例。观察患者术后24 h(T1)、48 h(T2)的生命体征,包括HR、MAP、呼吸频率(respiratory rate,RR)、体温(temperature,T)、静息和运动状态数字评价量表(numerical rating scale,NRS)疼痛评分、镇静评分、活动情况评分、Bromage评分、不良事件等。结果T1、T2时两组生命体征和静息、运动状态NRS疼痛评分的差异无统计学意义(P>0.05)。两组术后镇静评分、术后恶心呕吐、皮肤瘙痒、尿潴留、补救镇痛、排气延迟的差异无统计学意义(P>0.05)。与B组相比,T1、T2时A组活动状态评分更低[(1.52±0.43)分比(1.83±0.51)分,P<0.05;(1.14±0.43)分比(1.22±0.40)分,P<0.05]。T1时Bromage评分更低[(1.02±0.32)分比(1.22±0.44)分,P<0.05]。T2时两组Bromage评分差异无统计学意义(P>0.05)。结论在TKA术后镇痛中,相对于CACB,SACB联合PCIA不仅可获得满意的术后镇痛,在Bromage评分和早期下地活动中更具优势,并且不增加不良反应发生率。Objective To compare the analgesic effects and the adverse events between single shot adductor canal blockade(SACB)combined with patient controlled intravenous analgesia(PC I A)and continuous adductor canal blockade(CACB)alone in postoperative analgesia after total knee arthroplasty(TKA).Methods Postoperative analgesia schemes of patients with TKA were retrospectively analyzed,with 46 cases in SACB combined with PCIA group(group A)and 43 cases in CACB group(group B)from January 2018 to December 2019.Hemodynamic parameters and numerical rating scale(NRS)were recorded at24 h and 48 h postoperatively.Mental state,activity,adverse events(nausea,vomiting,skin itching,urinary retention,temporary pain treatment,delayed exhaust)were also analyzed.Results There were no significant differences in HR,MAP,RR,T and NRS at T1 and T2 between the two groups.There were no significant differences in sedation score,postoperative nausea and vomiting,skin pruritus,urinary retention,temporary pain treatment and exhaust delay between the two groups.Compared with group A,the activity score of group B was higher at T1 and T2,and the difference was statistically significant[(1.52±0.43)vs.(1.83±0.51),P<0.05;(1.14±0.43)vs.(1.22±0.40),P<0.05].The Bromage score of group A was lower at T1,and the difference was statistically significant[(1.02±0.32)vs.(1.22±0.44),P<0.05].There was no significant difference in Bromage score between the two groups at T2.Conclusions Compared with CACB,SACB combined with PCIA could significantly reduce postoperative pain without increasing the incidence of adverse events,accompanied by lower Bromage score and earlier functional exercise.

关 键 词：单次收肌管阻滞 连续收肌管阻滞 全膝关节置换术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]