床旁超声引导下连续隐神经阻滞联合全身麻醉在老年膝关节置换术中的应用效果及其对定向力、股四头肌肌力的影响  

Application effect of continuous saphenous nerve block combined with general anesthesia under bedside ultrasound guidance on elderly knee replacement surgery and the influence of directional force and quadriceps muscle strength

作　　者：同红伟 陈小春 王燕[1] TONG Hong-wei;CHEN Xiao-chun;WANG Yan(Department of Surgery and Anesthesiology,Yan'an People's Hospital,Yan'an Shaanxi 716000,China)

机构地区：[1]延安市人民医院手术麻醉科,陕西延安716000

出　　处：《临床和实验医学杂志》2024年第10期1114-1118,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省科协企业创新争先青年人才托举计划(编号:2021-1-2)。

摘　　要：目的探讨床旁超声引导下连续隐神经阻滞联合全身麻醉在老年膝关节置换术中的应用效果及其对定向力、股四头肌肌力的影响。方法回顾性选取2020年11月至2023年11月在延安市人民医院行膝关节置换术的102例老年患者,按照麻醉方法不同分为观察组与对照组,每组各51例。所有患者术中均采取0.3μg/kg舒芬太尼,0.03 mg/kg咪达唑仑,0.3 mg/kg依托咪酯与0.2 mg/kg顺式阿曲库铵进行全身麻醉,对照组术后进行超声引导下连续股神经阻滞,观察组术后进行超声引导下连续隐神经阻滞,麻醉药物均为20 mL 0.2%罗哌卡因,持续阻滞48 h。比较两组患者术后1、4、8、12、24、48 h静息与活动时疼痛数字评分法(NRS)评分,术后3、5及7 d采用Berg平衡量表(BBS)评价其定向力,比较其术后4、6、8、12、24、48 h股四头肌肌力变化,比较两组患者术后1、7 d血清应激反应指标水平,并比较两组患者下床时间及远期膝关节功能。结果两组患者术后1、4、8、12、24、48 h活动时NRS评分与静息时NRS评分比较,差异均无统计学意义(P>0.05)。观察组术后3、5、7 d的BBS评分分别为(37.96±5.21)、(43.06±5.13)、(49.27±3.34)分,均明显高于对照组[(31.91±6.32)、(38.57±4.15)、(41.36±4.44)分],差异均有统计学意义(P<0.05)。术后4 h,两组患者股四头肌肌力比较,差异无统计学意义(P>0.05);观察组术后6、8、12、24、48 h股四头肌肌力分别为(1.95±0.13)、(2.42±0.15)、(2.75±0.41)、(3.11±0.33)、(3.93±0.42)分,均高于对照组[(1.56±0.20)、(2.01±0.13)、(2.14±0.23)、(2.76±0.42)、(3.11±0.35)分],差异均有统计学意义(P<0.05)。术后1 d,两组患者皮质醇、去甲肾上腺素、肾上腺素水平比较,差异均无统计学意义(P>0.05);术后7 d,两组患者皮质醇、去甲肾上腺素、肾上腺素水平均较术后1 d降低,差异均有统计学意义(P<0.05),但两组患者术后7 d皮质醇、去甲肾上腺素、肾上腺素水平比较,Objective To explore the application effect of continuous saphenous nerve block combined with general anesthesia under bedside ultrasound guidance on elderly knee replacement surgery and the influence of directional force and quadriceps muscle strength.Methods A total of 102 elderly patients who underwent knee joint replacement surgery at Yan'an People's Hospital from November 2020 to November 2023 were retrospectively selected and divided into the observation group and the control group according to the different anesthesia methods,with 51 cases in each group.All patients underwent general anesthesia with 0.3μg/kg sufentanil,0.03 mg/kg midazolam,0.3 mg/kg etomidate,and 0.2 mg/kg cisatracurium during surgery.The control group underwent ultrasound-guided continuous femoral nerve block after surgery,while the observation group underwent ultrasound-guided continuous saphenous nerve block after surgery.The anesthetic was 20 mL 0.2%ropivacaine for 48 hours.The resting and active pain numerical scale(NRS)scores of two groups of patients at 1 hour,4 hours,8 hours,12 hours,24 hours,and 48 hours after surgery were compared.The directional force of two groups of patients at 3 days,5 days,and 7 days after surgery was evaluated using the Berg balance scale(BBS).The changes in quadriceps muscle strength at 4 hours,6 hours,8 hours,12 hours,24 hours,and 48 hours after surgery of two groups of patients were compared.The levels of serum stress response indicators at 1 day,and 7 days after surgery,and finally first time of got out of bed and long-term knee joint function of two groups of patients were compared.Results There were no statistically significant differences in NRS score during activity and NRS score at rest between the two groups of patients at 1 hour,4 hours,8 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05);The BBS scores of the observation group at 3,5,and 7 days after surgery were(37.96±5.21),(43.06±5.13),and(49.27±3.34)points,respectively,which were significantly higher than those of the control grou

关 键 词：超声引导 连续隐神经阻滞 全身麻醉 膝关节置换术 定向力 股四头肌肌力 

分 类 号：R614.2[医药卫生—麻醉学]