腘窝坐骨神经联合股神经阻滞在膝关节镜中的应用研究  

Application of Popliteal Sciatic Nerve Combined with Femoral Nerve Block in Knee Arthroscopy

作　　者：唐玉霞 孙强 赖金明 TANG Yuxia;SUN Qiang;LAI Jinming(Department of anesthesiology,Anyuan county people's hospital,Ganzhou,Jiangxi 342100;Department of urology,Anyuan county people's hospital)

机构地区：[1]安远县人民医院麻醉科,江西赣州342100 [2]安远县人民医院泌尿外科

出　　处：《中国伤残医学》2024年第6期41-45,共5页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:研究腘窝坐骨神经联合股神经阻滞在膝关节镜中的应用.方法:选取2020年1月-2022年6月在安远县人民医院进行膝关节镜手术的60例患者,随机将患者分为神经阻滞组和硬外膜组,每组各30例,硬膜外组患者采用连续硬膜外麻醉后进行手术,神经阻滞组患者采用腘窝坐骨神经联合股神经阻滞麻醉后进行手术.比较2组患者麻醉效果,比较2组患者麻醉前(T_(0))、麻醉后15分钟(T_(1))、麻醉后60分钟(T_(2))、手术结束时(T_(3))的心率(HR)和平均动脉压(MAP),比较2组患者感觉和运动神经阻滞起效时间、持续时间,比较2组患者术后各时间点膝关节主动屈曲角度,比较2组患者股四头肌肌力,比较2组患者不良反应发生情况.结果:神经阻滞组和硬膜外组患者T_(0)、T_(1)、T_(2)、T_(3)时HR水平比较,差异无统计学意义(P>0.05);神经阻滞组和硬膜外组患者T_(0)时MAP比较,差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,神经阻滞组患者MAP水平均高于硬膜外组,差异有统计学意义(P<0.05);神经阻滞组感觉和运动神经阻滞起效时间均短于硬膜外组,持续时间均长于硬膜外组,差异有统计学意义(P<0.05);术后1天,神经阻滞组和硬膜外组患者膝关节主动屈曲角度比较,差异无统计学意义(P>0.05);术后3天、7天神经阻滞组患者膝关节主动屈曲角度大于硬膜外组患者,差异有统计学意义(P<0.05);术后6小时、24小时,神经阻滞组患者股四头肌肌力评分低于硬膜外组患者,差异有统计学意义(P<0.05);神经阻滞组患者不良反应发生发生率为10.00%,与硬膜外组不良反应发生发生率20.00%比较,差异无统计学意义(P>0.05).结论:腘窝坐骨神经联合股神经阻滞麻醉能够减轻膝关节镜手术患者应激反应,缩短麻醉起效时间,并延长麻醉作用时间.Objective:To study the application of popliteal sciatic nerve combined with femoral nerve block in knee arthroscopy.Methods:A total of 60 patients who underwent knee arthroscopic surgery in People's Hospital of Anyuan County from January 2020 to June 2022 were selected and randomly divided into a nerve block group and an epidural group,with 30 patients in each group.Patients in the epidural group underwent surgery after continuous epidural anesthesia,and patients in the nerve block group underwent surgery after popliteal sciatic nerve combined with femoral nerve block anesthesia.The anesthesia effect was compared between the two groups.The heart rate(HR)and mean arterial pressure(MAP)were compared before anesthesia(T_(0)),15 min after anesthesia(T_(1)),60 min after anesthesia(T_(2)),and at the end of operation(T_(3)).The onset time and duration of sensory and motor nerve block were compared between the two groups.The active flexion Angle of knee joint at each time point after operation,the muscle strength of quadriceps femoris of the two groups,and the incidence of adverse reactions of the two groups were compared.Results:There was no significant difference in HR levels at T_(0),T_(1),T_(2) and T_(3) between the nerve block group and the epidural group(P>0.05).There was no significant difference in MAP at T_(0) between nerve block group and epidural group(P>0.05).At T_(1),T_(2) and T_(3),the MAP levels of patients in the nerve block group were higher than those in the epidural group,and the differences were statistically significant(P<0.05);The onset time of sensory and motor nerve block in nerve block group was shorter than that in epidural group,and the duration of sensory and motor nerve block was longer than that in epidural group,and the differences were statistically significant(P<0.05);At 1 day after operation,there was no significant difference in the knee joint active flexion Angle between the nerve block group and the epidural group(P>0.05).The active flexion An-gle of the knee joint in the nerve block

关 键 词：股神经阻滞麻醉 腘窝坐骨神经阻滞麻醉 连续硬膜外麻醉 膝关节镜 

分 类 号：R687[医药卫生—骨科学]