超声引导下收肌管联合膝关节囊后间隙阻滞对全膝关节置换术老年患者苏醒期谵妄的影响  

The effect of ultrasound-guided myofascial tube combined with knee joint posterior capsule space block on postoperative delirium in elderly patients undergoing total knee arthroplasty

作　　者：刘佳[1] 王晓亮[2] 张文文[2] 徐亚杰[2] 张勇[2] 方兆晶[2] 朱丽丽[2] Liu Jia;Wang Xiaoliang;Zhang Wenwen;Xu Yajie;Zhang Yong;Fang Zhaojing;Zhu Lili(Department of Pharmacy,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)药剂科,南京210006 [2]南京医科大学附属南京医院(南京市第一医院)麻醉疼痛与围术期医学科,南京210006

出　　处：《中国医师杂志》2024年第3期354-359,共6页Journal of Chinese Physician

基　　金：国家自然科学基金(81971872)。

摘　　要：目的评价超声引导下收肌管联合膝关节囊后间隙阻滞对全膝关节置换术(TKA)老年患者苏醒期谵妄的影响。方法选择2021年12月至2022年12月于南京市第一医院择期行单侧TKA的68例老年患者,采用随机数字表法分为对照组(n=34)和观察组(n=34),两组均采用全身麻醉,观察组在手术开始前进行超声引导下收肌管联合膝关节囊后间隙阻滞。观察两组患者术后24 h内谵妄的发生率,记录患者手术时间、苏醒时间、术中失血量、输液量及丙泊酚、瑞芬太尼使用总量;记录患者术后4、8、24 h各时点的静息和运动视觉模拟量表(VAS)评分;测定患者术前一天、术后当晚、术后第一天血清肿瘤坏死因子-α(TNF-α)、褪黑素水平;记录术后第一天主观睡眠质量评分;记录术后24 h内患者自控静脉镇痛(PCIA)舒芬太尼总用量、PCIA的有效按压次数(P1)和实际按压次数(P2)及追加羟考酮镇痛例数;记录术后24 h内呼吸抑制、镇静过度、恶心、呕吐发生情况;记录观察组神经阻滞并发症的发生情况。结果观察组苏醒期谵妄发生率低于对照组(P<0.05)。观察组丙泊酚、瑞芬太尼用量少于对照组(均P<0.05),苏醒时间短于对照组(P<0.05)。观察组术后4、8、24 h静息和运动VAS评分低于对照组(均P<0.05)。与术前一天比较,观察组术后当晚褪黑素水平升高(P<0.05),术后第一天TNF-α水平升高(P<0.05);对照组术后第一天褪黑素水平降低(P<0.05),术后当晚、术后第一天TNF-α水平升高(均P<0.05)。观察组术后当晚、术后第一天血清褪黑素水平高于对照组(均P<0.05),TNF-α水平低于对照组(均P<0.05)。观察组主观睡眠质量评分,术后24 h内PCIA舒芬太尼总用量、P1、P2及追加羟考酮镇痛例数少于对照组(均P<0.05)。对照组(13例,38.2%)恶心发生率高于观察组(3例,8.8%)(P<0.05)。结论在全身麻醉下行单侧TKA的老年患者中,术前采用超声引导下收肌管联合膝关节囊Objective To evaluate the effect of ultrasound-guided adductor canal combined with knee joint posterior capsule space block on the recovery period delirium in elderly patients undergoing total knee arthroplasty(TKA).Methods A total of 68 elderly patients who underwent unilateral TKA at the Nanjing First Hospital from December 2021 to December 2022 were selected.They were randomly divided into a control group(n=34)and an observation group(n=34)using a random number table method.Both groups received general anesthesia,and the observation group received ultrasound-guided myofascial tube combined with knee joint posterior capsule space block before the surgery began.The incidence of delirium within 24 hours after surgery was mainly observed in two groups of patients.The surgical time,recovery time,intraoperative blood loss,infusion volume,total use of propofol and remifentanil were recorded;The resting and motor Visual Analogue Scale(VAS)scores of the patient were recorded at 4,8,and 24 hours postoperatively.The patient′s serum tumor necrosis factor-α(TNF-α)and melatonin levels were measured on the day before surgery,the evening after surgery,and the first day after surgery.The subjective sleep quality score was recorded on the first day after surgery;The total dosage of sufentanil for patient-controlled intravenous analgesia(PCIA)within 24 hours after surgery,the effective number of compressions(P1)and actual number of compressions(P2)of PCIA,and the number of cases of additional oxycodone analgesia were recorded;The occurrence of respiratory depression,excessive sedation,nausea,and vomiting within 24 hours after surgery was recorded;The occurrence of complications of nerve block in the observation group was recorded.Results The incidence of delirium during the recovery period in the observation group was lower than that in the control group(P<0.05).The dosage of propofol and remifentanil in the observation group was lower than that in the control group(all P<0.05),and the awakening time was shorter than that in

关 键 词：关节成形术 置换 膝 神经传导阻滞 苏醒谵妄 

分 类 号：R614[医药卫生—麻醉学]