W入路与C联合W入路对全膝关节置换术影响的对比研究  

A comparative study of the effects of the W approach and the C combined W approach on TKA

作　　者：刘艳芳[1] 程文杰 孙晓华[1] 任万陆 Liu Yanfang;Cheng Wenjie;Sun Xiaohua;Ren Wanlu(Department of AnesthesiologY,Tianjin Hospital,Tianjin 300221,China)

机构地区：[1]天津医院麻醉科,300221

出　　处：《山西医药杂志》2025年第5期323-329,共7页Shanxi Medical Journal

摘　　要：目的比较超声和神经刺激仪联合引导下Winnie入路(W入路)与Capdevila(C)联合W入路行腰丛神经阻滞对全膝关节置换术(TKA)患者术后镇痛的影响。方法选择择期行单侧膝关节置换术患者60例,美国麻醉医师协会(ASA)Ⅰ或Ⅱ级,性别不限,年龄50~65岁。采用随机数字表法将患者分为2组(n=30):W入路组和C联合W入路组。C联合W入路组:超声和神经刺激仪联合引导下,采用C入路联合W入路行腰丛神经阻滞,每个入路各注射0.4%罗哌卡因20 ml;W入路组:超声和神经刺激仪联合引导下,只采用W入路行腰丛神经阻滞,注射0.4%罗哌卡因40 ml。2组待腰丛完成后,超声和神经刺激仪联合引导下再采用Labat入路行坐骨神经阻滞。记录2组定位失败情况,评估腰丛神经阻滞情况,记录操作完成时间,感觉和运动阻滞起效及维持时间,总阻滞起效时间。术后2组患者均采用静脉舒芬太尼自控镇痛。比较2组T1至T7各时间点无创平均动脉压和心率变化。比较术后各时间点静息及活动时视觉模拟评分(VAS),术后48 h镇痛方案满意度评分,舒芬太尼用量及不良反应发生情况。结果通过比较不同时间点无创平均动脉压和心率后发现差异无统计学意义。2组定位失败率和阻滞失败率差异无统计学意义。与W入路组相比,C联合W入路组感觉阻滞、运动阻滞及维持时间均缩短,操作时间延长(P<0.05)。C联合W入路组术后各时间点活动时VAS评分降低(P<0.05),术后舒芬太尼累积用量减少(P<0.05),不良反应的发生率降低(P<0.05);2组术后48 h满意度评分差异无统计学意义。结论2种方法引导TKA患者行腰丛神经阻滞时推荐采用C入路联合W入路给药方式。Objective To compare the Winnie approach(W approach)and the Capdevila(C)combined with the W approach for lumbar plexus nerve block guided by ultrasound combined with nerve stimulator and observe the analgesic effect on patients after total knee arthroplasty(TKA).Methods Sixty American Society of Anesthesiologists(ASA)physical statusⅠorⅡpatients of both sexes,aged 50~65y,undergoing elective total knee replacement were randomly divided into 2 groups(n=30 each)using a random number table:the W approach group and the C combined with W approach group.Lumbar plexus nerve block was performed under the guidance of ultrasound combined with nerve stimulator.For the C combined with W approach group,the C and W approach were used for the lumbar plexus block.Each approach was injected with 0.4%ropivacaine 20ml.For the W approach group,only the W approach was used for the lumbar plexus block,and 40 ml 0.4%ropivacaine was injected.After the lumbar plexus was completed,a sciatic nerve block was performed by the Labat approach in both groups guided by ultrasound combined with a nerve stimulator.The time spent performing the block,onset time and duration of sensory and motor blockade were recorded.Success or failure of nerve block was assessed.All patients were treated with sufentanil for postoperative patient-controlled analgesia.Heart rate(HR),mean arterial pressure(MAP)between the two groups at the following time points:1 min before tourniquet inflation(T1),every 15 min during tourniquet inflation(T2,T3,T4,T5,and T6,respectively),and1min after tourniquet deflation(T7)were compared.The visual analogue scale(VAS)scores at rest and activity at6,12,24,and 48 h after operation,the satisfaction score of the analgesic regimen at 48h after operation,the dosage of sufentanil and the occurrence of adverse reactions.Results There was no significant difference between mean noninvasive arterial pressure and heart rate at different time points.In addition,there was no significant difference in the localization failure rate and the block

关 键 词：神经阻滞 腰丛神经 全膝关节置换术 血流动力学 

分 类 号：R61[医药卫生—外科学]