隐神经联合膝关节囊后阻滞对全膝关节置换术后应激反应、镇痛效应及关节功能恢复的影响  

Effects of saphenous nerve combined with posterior capsular block of knee joint on stress response,analgesic effect and joint function recovery after total knee arthroplasty

作　　者：冯腾尘 王佳奕 姚杰[1] 赵继波[1] 孙晓佳 李福龙[1] FENG Teng-chen;WANG Jia-yi;YAO Jie;ZHAO Ji-bo;SUN Xiao-jia;LI Fu-long(Department of Anesthesiology,the First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院麻醉科,河北张家口075000

出　　处：《局解手术学杂志》2024年第6期509-513,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：2022年度河北省科学研究课题计划项目(20220620);张家口市科技技术局项目(2121134D)。

摘　　要：目的探讨隐神经联合膝关节囊后阻滞对全膝关节置换患者术后应激反应、镇痛效应及关节功能恢复的影响。方法纳入2021年1月至2022年1月我院择期行全膝关节置换术的98例患者,按照随机数字表法分为观察组(采用隐神经联合膝关节囊后阻滞)和对照组(采用单纯隐神经阻滞),每组49例。比较术后6 h、12 h、24 h 2组患者静息和动态疼痛视觉模拟量表(VAS)评分;比较术前、术后3 d、术后5 d、术后7 d 2组患者膝关节活动度;比较术前、术后4 h、术后12 h、术后24 h、术后48 h 2组患者应激指标[皮质醇(Cor)、促肾上腺皮质激(ACTH)]及疼痛介质指标[降钙素基因相关肽(CGRP)、β-内啡肽(β-EP)、6-酮前列腺素E1α(6-keto-PGE1α)、P物质(SP)];记录2组患者治疗期间不良反应发生情况。结果2组患者不同时间点静息和动态VAS评分在时间因素、组间因素和时间与组间交互作用方面比较,差异具有统计学意义(P<0.05);2组患者不同时间点膝关节活动度在时间因素、组间因素和时间与组间交互作用方面比较,差异具有统计学意义(P<0.05);2组患者不同时间点Cor、ACTH含量在时间因素、组间因素和时间与组间交互作用方面比较,差异具有统计学意义(P<0.05);2组患者不同时间点β-EP、SP、CGRP、6-keto-PGE1α含量在时间因素、组间因素和时间与组间交互作用方面比较,差异具有统计学意义(P<0.05);2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论全膝关节置换术中采用隐神经联合膝关节囊后阻滞,可减少患者应激反应,提升术后镇痛效应,改善早期运动功能,安全性高。Objective To investigate the effects of saphenous nerve combined with posterior capsular block of knee joint on stress response,analgesic effect and joint function recovery of patients after total knee arthroplasty.Methods A total of 98 patients who received total knee arthroplasty in our hospital from January 2021 to January 2022 were selected and divided into the observation group(received saphenous nerve combined with posterior capsular block of knee joint)and the control group(received saphenous nerve block)by random number table,with 49 patients in each group.The visual analogue scale(VAS)score of resting and dynamic pain 6 hours,12 hours and 24 hours after surgery of patients in the two groups were compared.The range of knee joint motion before surgery,3 days,5 days and 7 days after surgery of patients in the two groups were compared.The stress indexes[cortisol(Cor),adrenocorticotropic hormone(ACTH)],and pain mediator indexs[calcitonin gene-related peptide(CGRP),beta-endorphins(β-EP),6-keto prostaglandin E1α(6-Keto-pGE1α),substance P(SP)]before surgery,4 hours,12 hours,24 hours,and 48 hours after surgery of patients in the two groups were compared.The occurrence of adverse reactions during treatment of patients in the two groups were recorded.Results There were statistically significant differences in the resting and dynamic VAS scores at different time points of patients in the two groups in terms of time factors,inter-group factors and interaction factors(P<0.05).There were statistically significant differences in the range of knee joint motion at different time points of patients in the two groups in terms of time factors,inter-group factors and interaction factors(P<0.05).There were statistically significant differences in the Cor and ACTH contents at different time points of patients in the two groups in terms of time factors,inter-group factors and interaction factors(P<0.05).There were statistically significant differences in the contents ofβ-EP,SP,CGRP and 6-keto-PGE1αat different time points o

关 键 词：隐神经阻滞 膝关节囊后阻滞 全膝关节置换术 应激反应 疼痛介质 

分 类 号：R614.4[医药卫生—麻醉学]