IPACK-收肌管阻滞联合TIVA在膝关节置换术麻醉中的应用  

Application of interspace between the popliteal artery and capsule of the knee-adductor canal block combined with total intravenous anesthesia in anesthesia of total knee arthroplasty

作　　者：张宝平[1] 贾淑红 蔡亮[1] ZHANG Bao-ping;JIA Shu-hong;CAI Liang(The Second Department of Anesthesiology,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,Shaanxi,CHINA)

机构地区：[1]西安交通大学附属红会医院麻醉二科,陕西西安710054

出　　处：《海南医学》2023年第1期34-37,共4页Hainan Medical Journal

摘　　要：目的 探讨膝关节囊后间隙阻滞(IPACK)-收肌管阻滞联合全凭静脉麻醉(TIVA)在膝关节置换术(TKA)麻醉中的应用效果。方法 选择2018年6月至2021年5月在西安交通大学附属红会医院行TKA治疗的100例患者为研究对象,按随机数表法分为观察组和对照组各50例。对照组患者给予TIVK麻醉,观察组患者在对照组基础上联合IPACK-收肌管阻滞麻醉。比较两组患者术后6 h、12 h、24 h、48 h的视觉模拟疼痛(VAS)评分、股四头肌肌力、膝关节活动度变化,以及苏醒情况和不良反应发生情况。结果 观察组患者术后6 h、12 h、24 h、48 h时静息、运动状态的VAS评分[(1.68±0.32)分、(1.88±0.41)分、(2.41±0.39)分、(2.11±0.28)分]、[(2.16±0.35)分、(2.47±0.18)分、(3.41±0.42)分、(2.81±0.38)分]明显低于对照组[(1.85±0.23)分、(2.18±0.73)分、(2.78±0.31)分、(2.57±0.30)分]、[(2.34±0.28)分、(2.66±0.14)分、(3.79±0.35)分、(3.12±0.35)分],差异均有统计学意义(P<0.05);观察组患者的自主呼吸恢复时间、苏醒时间及拔管时间分别为(7.31±1.22) min、(7.98±1.09) min、(10.43±2.11) h,明显短于对照组的(9.89±1.78) min、(12.13±2.21) min、(15.41±9.41) h,差异均有统计学意义(P<0.05);术后12 h、24 h、48 h,两组患者的股四头肌肌力、膝关节活动度均升高,且观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的总不良反应发生率分别为10.00%、16.00%,差异无统计学意义(P>0.05)。结论 IPACK-收肌管阻滞联合TIVA应用于TKA术中的麻醉效果理想,可缓解术后疼痛,提高肌力,增加关节活动度,安全可靠。Objective To investigate the application effect of interapace between the popliteal artery and capsule of the Knee(IPACK)-adductor canal block combined with total intravenous anesthesia(TIVA) in the anesthesia of total knee arthroplasty(TKA). Methods A total of 100 patients who underwent TKA treated in the Honghui Hospital Affiliated to Xi’an Jiaotong University from June 2018 to May 2021 were selected as the study subjects. According to the random number table method, all patients were divided into an observation group and a control group, with 50 patients in each group. The patients in the control group were given TIVA anesthesia, and the patients in the observation group were given IPACK-adductor block anesthesia on the basis of the control group. The Visual Analogue Pain(VAS) score,quadriceps muscle strength, knee joint mobility, recovery, and adverse reactions were compared between the two groups at 6 h, 12 h, 24 h and 48 h after operation. Results The VAS scores in the observation group at 6 h, 12 h, 24 h and 48 h after operation were(1.68±0.32) points,(1.88±0.41) points,(2.41±0.39) points,(2.11±0.28) points at rest, and(2.16±0.35) points,(2.47±0.18) points,(3.41±0.42) points,(2.81±0.38) points at exercise, which were significantly lower than(1.85±0.23) points,(2.18±0.73) points,(2.78±0.31) points,(2.57±0.30) points at rest,(2.34±0.28) points,(2.66±0.14) points,(3.79±0.35) points,(3.12±0.35) points at exercise in the control group(P<0.05). The recovery time of spontaneous respiration, recovery time, and extubation time in the observation group were(7.31±1.22) min,(7.98±1.09) min, and(10.43±2.11) h, which were significantly shorter than(9.89±1.78) min,(12.13±2.21) min, and(15.41±9.41) h in the control group(P<0.05). At 12 h, 24 h, and 48 h after operation, the muscle strength of quadriceps femoris and knee joint mobility of the two groups were increased, and those were significantly higher in the observation group than the control group, with statistically significant differences(P<0.

关 键 词：膝关节置换术 神经传导阻滞 全凭静脉麻醉 疼痛 股四头肌力 膝关节活动度 不良反应 

分 类 号：R687.4[医药卫生—骨科学]