收肌管隐神经阻滞麻醉在单侧全膝关节置换术老年患者中的应用效果  

Application effect of saphenous nerve block anesthesia within adductor canal in elderly patients undergoing unilateral total knee arthroplasty

作　　者：夏林智 雷震 杨晶晶 鲁齐林 XIA Lin-zhi;LEI Zhen;YANG Jing-jing;LU Qi-lin(Department of Anesthesiology Hubei NO.672 Integrated Traditional Chinese and Western Medicine Orthopedic Hospital,Wuhan 430070,Hubei,China;The Second Department of Spinal Surgery,Hubei NO.672 Integrated Traditional Chinese and Western Medicine Orthopedic Hospital,Wuhan 430070,Hubei,China)

机构地区：[1]湖北六七二中西医结合骨科医院麻醉科,湖北省武汉市430070 [2]湖北六七二中西医结合骨科医院脊柱外二科,湖北省武汉市430070

出　　处：《广西医学》2022年第12期1328-1331,1345,共5页Guangxi Medical Journal

基　　金：湖北省武汉市医学科研项目(WX19B06)。

摘　　要：目的探讨收肌管隐神经阻滞麻醉在单侧全膝关节置换术(TKA)老年患者中的应用效果。方法回顾性分析120例单侧TKA老年患者的临床资料,根据不同神经阻滞麻醉方法将其分成A组与B组,每组60例。A组采用收肌管隐神经阻滞麻醉,B组采用股三角阻滞麻醉。比较两组患者苏醒质量(麻醉复苏室停留时间、拔除气管导管时间),术后不同时间点的疼痛视觉模拟量表(VAS)评分、股四头肌肌力分级评分及膝关节活动度,以及术后镇痛情况(镇痛泵按压次数、补救镇痛次数)及不良反应发生情况。结果A组患者的麻醉复苏室停留时间与拔除气管导管时间均短于B组,术后镇痛泵按压次数与补救镇痛次数均少于B组(均P<0.05)。术后不同时间点,A组患者的疼痛VAS评分均低于B组,股四头肌肌力分级评分及膝关节活动度均优于B组(均P<0.05)。两组患者术后不良反应发生率差异无统计学意义(P>0.05)。结论相比于股三角阻滞麻醉,收肌管隐神经阻滞麻醉可提高单侧TKA老年患者的苏醒质量,明显减轻患者的术后疼痛,对股四头肌肌力与膝关节活动度的影响小,镇痛效果满意,安全性较高。Objective To investigate the application effect of saphenous nerve block anesthesia within adductor canal in elderly patients undergoing unilateral total knee arthroplasty(TKA).Methods The clinical data of 120 patients undergoing unilateral TKA were retrospectively analyzed.According to different nerve block anesthesia methods,they were divided into group A or group B,with 60 cases in each group.Group A was anesthetized with saphenous nerve block within adductor canal,whereas group B was anesthetized with femoral triangle block.The quality of recovery(the length of anesthesia resuscitation room stay,and the time of extubation of tracheal catheter),the Visual Analogue Scale(VAS)score for pain at various time points after operation,the score of quadriceps femoris muscle strength classification,and the range of motion of knee joint,as well as postoperative analgesic conditions(analgesia pump pressure times,and remedial analgesia times)and the incidence of adverse reactions in patients was compared between the two groups.Results The length of anesthetic resuscitation room stay and extubation time of tracheal catheter in group A were shorter than those in group B,and the postoperative analgesia pump pressure times and the times of remedial analgesia in group A were less than those in group B(all P<0.05).At various time points after operation,the VAS score for pain in group A was lower than that in group B,and the score of quadriceps femoris muscle strength classification and range of motion of knee joint were superior to those in group B(all P<0.05).There was no statistically significant difference in the incidence rate of postoperative adverse reactions in patients between the two groups(P>0.05).Conclusion Compared with femoral triangle block anesthesia,saphenous nerve block anesthesia within adductor canal in elderly patients undergoing unilateral TKA can improve the quality of recovery,significantly alleviate postoperative pain,exerting slight influence on quadriceps femoris muscle strength and range of motion of k

关 键 词：收肌管隐神经阻滞麻醉 股三角阻滞麻醉 全膝关节置换术 术后疼痛 苏醒质量 股四头肌肌力 膝关节活动度 镇痛效果 老年人 

分 类 号：R614.4[医药卫生—麻醉学]