超声引导下收肌管阻滞对老年膝关节置换术患者术后认知功能及静脉血栓栓塞形成的影响  

Influence of ultrasound-guided adductor canal block on postoperative cognitive function and venous thromboembolism in elderly patients with total knee arthroplasty surgery

作　　者：吴清海[1] 杨进国[1] 李玉珍 陈羽 喻晓敏[1] Wu Qinghai;Yang Jinguo;Li Yuzhen;Chen Yu;Yu Xiaomin(Department of Anesthesiology,Dongfeng General Hospital of Chinese Medicine Affiliated to Hubei University of Medicine,Shiyan 442008,Hubei,China)

机构地区：[1]湖北医药学院附属国药东风总医院麻醉科,湖北十堰442008

出　　处：《血管与腔内血管外科杂志》2024年第10期1254-1258,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的探究超声引导下收肌管阻滞(ACB)对老年膝关节置换术(TKA)患者术后认知功能及静脉血栓栓塞形成的影响。方法收集2022年1月至2023年12月于湖北医药学院附属国药东风总医院进行TKA的80例老年患者的临床资料,根据镇痛方式的不同分为对照组(n=39,采用单纯蛛网膜下腔阻滞)和观察组(n=41,采用蛛网膜下腔阻滞+超声引导下ACB)。比较两组患者手术前后认知功能、手术前后疼痛情况、术后第7天的股四头肌肌力和关节活动度、不同年龄段患者术后静脉血栓栓塞发生情况以及术后不良反应发生情况。结果术前,两组患者的认知功能评分、疼痛评分、股四头肌肌力评分、关节活动度比较,差异均无统计学意义(P﹥0.05);观察组患者术后第3天、术后第7天的认知功能评分均高于对照组患者,差异均有统计学意义(P﹤0.05);术后12、48 h,观察组患者的疼痛评分均低于对照组患者,差异均有统计学意义(P﹤0.05);术后第7天,观察组患者的股四头肌肌力评分高于对照组患者,关节活动度大于对照组患者,差异均有统计学意义(P﹤0.05)。观察组65~70岁患者术后静脉血栓栓塞的发生率低于对照组,差异均有统计学意义(P﹤0.05);两组71~80岁患者术后静脉血栓栓塞的发生率比较,差异无统计学意义(P﹥0.05)。两组患者的术后不良反应总发生率比较,差异无统计学意义(P﹥0.05);均未出现呼吸抑制的不良反应。结论老年TKA患者应用超声引导下能够减少患者术后认知功能障碍和静脉血栓栓塞的发生,减轻术后疼痛感,减少对股四头肌肌力和关节活动度的影响,且具有安全性。Objective To investigate the influence of ultrasound-guided adductor canal block(ABC)on postoperative cognitive function and venous thromboembolism in elderly patients with total knee arthroplasty(TKA)surgery.Method The clinical data of 80 elderly patients who received TKA surgery at Dongfeng General Hospital of Chinese Medicine Affiliated to Hubei University of Medicine from January 2022 to December 2023 were collected.The patients were divided into control group(n=39,simple spinal anesthesia)and observation group(n=41,spinal anesthesia+ultrasound-guided ACB)according to different analgesic methods.The cognitive function before and after surgery,pain levels before and after surgery,quadriceps muscle strength and joint mobility on the 7 d after surgery,occurrence of postoperative venous thromboembolism in patients of different age groups,and incidence of postoperative adverse reactions were compared between two groups of patients.Result Before surgery,there were no statistically significant differences in cognitive function scores,pain scores,quadriceps muscle strength scores and joint mobility between the two groups of patients(P>0.05);the cognitive function scores of the observation group patients on the 3 d and 7 d after surgery were higher than those of the control group patients,and the differences were statistically significant(P<0.05);the pain scores of the observation group patients at 12 h,48 h after surgery were lower than those of the control group patients,and the differences were statistically significant(P<0.05);on the 7 d after surgery,the quadriceps muscle strength scores of the observation group patients was higher than that of the control group patients,and the joint mobility was greater than that of the control group patients,and the differences were statistically significant(P<0.05).The incidence of postoperative venous thromboembolism in patients aged 65-70 years in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05);there

关 键 词：超声引导下收肌管阻滞 膝关节置换术 老年 认知功能 静脉血栓栓塞 

分 类 号：R543[医药卫生—心血管疾病]