本文選題：收肌管阻滯　切入點(diǎn)：膝關(guān)節(jié)置換　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年01期

【摘要】：目的:比較連續(xù)收肌管阻滯(adductor canal block,ACB)與連續(xù)股神經(jīng)阻滯(femoral nerve block,FNB)在全膝關(guān)節(jié)置換術(shù)后的臨床效果。方法:前瞻性觀察2016年4—9月因重度退行性骨關(guān)節(jié)炎行單側(cè)、初次膝關(guān)節(jié)置換的患者,隨機(jī)分為ACB組和FNB組。記錄患者術(shù)后2、6、12、24、48 h靜息及運(yùn)動(dòng)狀態(tài)下運(yùn)用疼痛數(shù)字分級(jí)法(numeric pain rating scales,NPRS)進(jìn)行的鎮(zhèn)痛評(píng)分、術(shù)前及術(shù)后24、48 h股四頭肌肌力、術(shù)后48 h內(nèi)阿片類藥物追加使用量、術(shù)后不良反應(yīng)等。結(jié)果:共納入40例患者,每組各20例,男∶女=7∶33,年齡(63.8±10.1)歲,體重指數(shù)(body mass index,BMI)為(28.5±3.5)kg/m~2。兩組患者在美國(guó)麻醉學(xué)會(huì)(American Society of Anesthesiologists,ASA)評(píng)分、術(shù)前畸形程度、疼痛評(píng)分、股四頭肌肌力、手術(shù)時(shí)間和止血帶使用時(shí)間方面差異無(wú)統(tǒng)計(jì)學(xué)意義。除術(shù)后2 h的靜息痛[ACB=0.0(0,6),FNB=3.0(0,5),P=0.004]和術(shù)后12 h的運(yùn)動(dòng)痛[ACB=3.0(3,0),FNB=5.5(0,10),P=0.004)外,其他時(shí)點(diǎn)兩組疼痛評(píng)分差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后24、48 h股四頭肌肌力,ACB組為(85.3±27.6)N和(82.0±30.1)N,FNB組為(69.0±29.4)N和(64.4±32.0)N,兩組均隨時(shí)間變化呈下降趨勢(shì),盡管具體數(shù)值A(chǔ)CB組高于FNB組,但組間差異無(wú)統(tǒng)計(jì)學(xué)意義(F=2.703,P=0.108)。術(shù)后24 h內(nèi)追加使用鹽酸哌替啶(100 mg/次)者,ACB組有4例,FNB組有5例;術(shù)后24~48 h內(nèi)追加者,ACB組3例,FNB組2例;所有追加均為1次。ACB組中,5例患者出現(xiàn)術(shù)后惡心,另有1例感到口干;FNB組惡心者4例,均同時(shí)伴有嘔吐,另有口干者3例,下肢肌間血栓患者2例。結(jié)論:膝關(guān)節(jié)置換術(shù)后,連續(xù)ACB的鎮(zhèn)痛效果并不優(yōu)于連續(xù)FNB,但ACB減小了對(duì)術(shù)后股四頭肌力的影響,有利于術(shù)后早期活動(dòng)。
[Abstract]:Objective: to compare the clinical effects of continuous adductor canal block and femoral nerve block after total knee arthroplasty.Methods: patients undergoing unilateral and primary knee arthroplasty due to severe degenerative osteoarthritis from April to September 2016 were randomly divided into ACB group and FNB group.The analgesic scores of patients with pain rating scales were recorded before and after 2448 h postoperatively and 48 h after operation. The analgesic scores of the patients were evaluated by digital pain grading method. The muscle strength of quadriceps femoris was 2448 h before and after operation, the additional use of opioid drugs within 48 h after operation, the adverse reactions after operation, and so on.Results: a total of 40 patients (20 cases in each group, male: female: 7: 33, age: 63.8 鹵10.1) years old, body mass index (BMI) was 28.5 鹵3.5 kg 路kg ~ (-1) 路m ~ (-1) 路min ~ (-1).There was no significant difference between the two groups in American Society of Anesthesiologists (ASA) score, preoperative deformity degree, pain score, quadriceps femoris muscle strength, operation time and tourniquet use time.Within 24 hours after operation, 4 cases were treated with pethidine hydrochloride (100 mg/), 5 cases in mg/ group, 3 cases in group A within 24 h after operation, 5 cases in group A, 5 cases in group A, 5 cases in group A, 5 cases in group A and 2 cases in group A within 24 h after operation.There were 4 cases of nausea in FNB group, 3 cases of dry mouth and 2 cases of intermuscular thrombosis of lower extremity.Conclusion: after knee arthroplasty, the analgesic effect of continuous ACB is not better than that of FNB, but ACB reduces the influence of quadriceps femoris muscle strength, which is beneficial to the early postoperative activities.
【作者單位】： 北京大學(xué)第三醫(yī)院骨科;北京大學(xué)第三醫(yī)院麻醉科;北京大學(xué)第三醫(yī)院臨床流行病學(xué)研究中心;
【分類號(hào)】：R687.4

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3 劉s，

本文編號(hào)：1727916