本文選題：股神經(jīng)阻滯　切入點(diǎn)：雞尾酒　出處：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的 通過(guò)觀察患者自控靜脈鎮(zhèn)痛（Patient controlled intravenous analgesia,PCIA）、超聲引導(dǎo)下連續(xù)股神經(jīng)阻滯（Continuous femoral nerve block,CFNB）與關(guān)節(jié)周圍注射雞尾酒法(Cocktail recipes mixed liquid analgesia,CRMA)用于全膝關(guān)節(jié)置換術(shù)(Total knee arthroplasty, TKA)后鎮(zhèn)痛效果，病人早期膝關(guān)節(jié)活動(dòng)，不良反應(yīng)發(fā)生率等，探討三種鎮(zhèn)痛方法的優(yōu)缺點(diǎn)，為尋找安全、有效及利于全膝關(guān)節(jié)置換術(shù)后患者早期膝關(guān)節(jié)功能恢復(fù)的鎮(zhèn)痛方法提供理論依據(jù)。 方法 選擇ASAI-III級(jí)擬行全膝關(guān)節(jié)置換術(shù)的患者63例，隨機(jī)分為三組，靜脈自控鎮(zhèn)痛組（PCIA組）21例，連續(xù)股神經(jīng)阻滯組（CFNA組）21例，雞尾酒組（CRMA組）21例，麻醉方法均采用氣管內(nèi)插管全身麻醉。PCIA組，負(fù)荷劑量芬太尼0.05mg，背景劑量為2ml/h, PCA每次2ml，鎖定時(shí)間為10min，持續(xù)48h。CFNA組在麻醉誘導(dǎo)插管后，利用超聲定位行股神經(jīng)阻滯并置管，給負(fù)荷劑量0.375%鹽酸羅哌卡因20ml，術(shù)后連接病人自控鎮(zhèn)痛泵（PCA），背景劑量為4.5ml/h，PCA每次4ml，鎖定時(shí)間為60min，持續(xù)48h。CRMA組于術(shù)中人工關(guān)節(jié)放置好后在關(guān)節(jié)腔周圍注射“雞尾酒”（0.75%鹽酸羅哌卡因50ml+嗎啡5mg+腎上腺素0.5mg+凱紛50mg+地塞米松5mg），并留置導(dǎo)管，在術(shù)后24h再推一次混合藥液（凱紛50mg+0.75%鹽酸羅哌卡因20ml）。記錄（觀察指標(biāo)）術(shù)后即刻、術(shù)后6h、12h、24h及48h患膝靜息及主被動(dòng)伸屈膝活動(dòng)時(shí)的疼痛評(píng)分，鎮(zhèn)靜評(píng)分，股四頭肌肌力，術(shù)后即刻、6h、12h、24h、48h患膝主動(dòng)屈曲時(shí)的角度，術(shù)后初次下床活動(dòng)時(shí)間，術(shù)后2周膝關(guān)節(jié)活動(dòng)度，術(shù)后不良反應(yīng)及并發(fā)癥的發(fā)生率，患者滿意度。所有資料采用Stata12.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，P㩳0.05時(shí)認(rèn)為差異有顯著性。 結(jié)果 PCIA組術(shù)后即刻、6h、12h、24h、48h的靜息狀態(tài)疼痛評(píng)分，均明顯高于CFNA組和CRMA組，差異有顯著性（P㩳0.05），CFNA組與CRMA組各時(shí)間點(diǎn)靜息狀態(tài)疼痛評(píng)分無(wú)明顯差異（P㧐0.05）。術(shù)后即刻、6h、12h、24h、48h，，三組患者主被動(dòng)伸屈膝活動(dòng)的疼痛評(píng)分差異有顯著性（P㩳0.05），PCIA組疼痛評(píng)分明顯高于CFNA組和CRMA組，在術(shù)后即刻、6h、24h，CFNA組疼痛評(píng)分與CRMA組相比差異無(wú)顯著性（P㧐0.05），但在術(shù)后12h及48h，CFNA組疼痛評(píng)分明顯低于CRMA組，差異有顯著性（P㩳0.05）。在術(shù)后即刻、6h、12h、24h、48h，三組患者的鎮(zhèn)靜評(píng)分比較差異無(wú)顯著性（P㧐0.05）。三組患者在術(shù)后即刻、6h、12h、24h、48h的肌力比較差異無(wú)顯著性（P㧐0.05）。在不引起劇烈疼痛的情況下，PCIA組在術(shù)后即刻、6h、12h、24h、48h的膝關(guān)節(jié)彎曲角度明顯小于CFNA組和CRMA組（P㩳0.05），CFNA組在術(shù)后即刻、6h、24h膝關(guān)節(jié)彎曲角度與CRMA組相比差異無(wú)顯著性（P㧐0.05），術(shù)后12h和48h時(shí)CFNA組膝關(guān)節(jié)彎曲角度明顯大于CRMA組（P㩳0.05）。PCIA組患者初次下床活動(dòng)時(shí)間明顯大于CFNA組和CRMA組，差異有顯著性（P㩳0.05），CFNA組與CRMA組患者初次下床活動(dòng)時(shí)間相比差異無(wú)顯著性（P㧐0.05）。術(shù)后兩周膝關(guān)節(jié)彎曲角度，PCIA組明顯小于CFNA組和CRMA組，差異有顯著性（P0.05），CFNA組和CRMA組相比差異無(wú)顯著性（P0.05）。三組患者不良反應(yīng)發(fā)生率，PCIA組明顯高于CFNA組和CRMA組，差異有顯著性（P㩳0.05）。術(shù)后患者滿意度PCIA組明顯低于CFNA組和CRMA組，差異有顯著性（P㩳0.05），而CFNA組和CRMA組相比，差異無(wú)顯著性（P㧐0.05）。 結(jié)論 TKA術(shù)后患者鎮(zhèn)痛，CFNA和CRMA的鎮(zhèn)痛效果明顯優(yōu)于PCIA；CFNA和CRMA對(duì)早期膝關(guān)節(jié)功能的恢復(fù)明顯優(yōu)于PCIA；CFNA較CRMA在持續(xù)性鎮(zhèn)痛方面更有優(yōu)勢(shì)。
[Abstract]:objective
Through the observation of patient-controlled intravenous analgesia (Patient controlled intravenous analgesia, PCIA), ultrasound-guided continuous femoral nerve block (Continuous femoral nerve block, CFNB) and periarticular injection (Cocktail recipes mixed liquid cocktail analgesia, CRMA) for total knee arthroplasty (Total knee, arthroplasty, TKA) after the analgesic effect of patients with early stage the knee joint activity, the incidence of adverse reactions, discuss advantages and disadvantages of the three kinds of methods of analgesia, to find safe, effective and beneficial to total knee arthroplasty in patients with knee joint function recovery analgesia methods and provide a theoretical basis.
Method
63 patients of grade ASAI-III underwent total knee replacement surgery, were randomly divided into three groups, intravenous analgesia group (PCIA group) 21 cases, continuous femoral nerve block group (CFNA group) 21 cases, cocktail group (CRMA group) 21 cases were treated with endotracheal intubation anesthesia group.PCIA general anesthesia a loading dose of fentanyl 0.05mg, background dose of 2ml/h, PCA, 2ml each time, the lock time is 10min, duration of 48h.CFNA group in intubation after induction of anesthesia, the use of ultrasound localization of femoral nerve block and tube, to a loading dose of 0.375% ropivacaine hydrochloride 20ml, postoperative patient-controlled analgesia pump connection (PCA), background dose was 4.5ml/h, PCA every time 4ml, the locking time is 60min, continuous 48h.CRMA group in artificial joint replacement in place around the "cocktail joint cavity" injection (0.75% 50ml+ morphine 5mg+ ropivacaine hydrochloride adrenaline 0.5mg+ flurbiprofen 50mg+ dexamethasone 5mg), and postoperative indwelling catheter, in 2 4h push again mixed liquor (flurbiprofen 50mg+0.75% ropivacaine hydrochloride (20ml). Record the observation index) immediately after surgery, postoperative 6h, 12h, 24h and 48h of knee resting and passive extension activities of the knee pain score, sedation score, unit four biceps muscle strength, immediately after the operation, 6h, 12h 24h, 48H, knee flexion angle when the first, postoperative ambulation time, degree of knee joint activity 2 weeks after operation, the incidence of adverse reactions, postoperative complications and patient satisfaction. All data were statistically analyzed using Stata12.0 software, P? 0.05 was considered significant.
Result
PCIA緇勬湳鍚庡嵆鍒

本文編號(hào)：1708002