本文選題：全膝關(guān)節(jié)置換 + 超聲　； 參考：《寧波大學(xué)》2017年碩士論文

【摘要】：目的:觀察全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)后超聲引導(dǎo)下收肌管阻滯(adductor canal blockade,ACB)對手術(shù)切口的鎮(zhèn)痛效果,擬探討收肌管阻滯在全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的有效性和可行性。方法:選擇2015年9月-2016年2月我院擇期全膝置換患者40例,采用隨機數(shù)字表法分成收肌管阻滯聯(lián)合靜脈自控鎮(zhèn)痛組(ACB+PCIA,A組))和單純靜脈自控鎮(zhèn)痛組(patient controlled intravenous analgesia,PCIA,P組),每組20例。兩組均在全麻下手術(shù),術(shù)畢A組在未全麻蘇醒前采用超聲引導(dǎo)下收肌管穿刺阻滯,收肌管內(nèi)注射0.5%羅哌卡因20mL,P組術(shù)后單純行PCIA。檢測兩組患者麻醉前(T_1)、術(shù)中(T_2)、術(shù)畢(T_3)、術(shù)后24小時(T_4)血糖濃度;同時經(jīng)頸內(nèi)靜脈采集血樣,采用放射免疫法測定腎上腺素(epinephrine,E)、去甲腎上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)濃度。記錄兩組患者羅哌卡因推注后1小時(POH1)、2小時(POH_2)、4小時(POH_4)、6小時(POH_6)、8小時(POH_8)、24小時(POH_24)靜息狀態(tài)和膝關(guān)節(jié)屈曲45°時疼痛視覺模擬評分(Visual analogue scale,VAS評分),Ramsay鎮(zhèn)靜評分和PCIA副反應(yīng)。結(jié)果:兩組T_4時血糖水平均明顯高于T_1、T_2、T_3時(P0.05);A組T_4時血糖水平明顯低于P組(P=0.001)。兩組T_2、T_3時E水平均明顯低于T_1、T_4時(P0.05);A組T_4時E水平明顯低于P組(P=0.029)。兩組T_4時NE水平均明顯高于T_1、T_2、T_3時(P0.05);A組T_4時NE水平明顯低于P組(P0.001)。P組T_4時DA水平均明顯高于T_1、T_2、T_3時(P0.05);A組T_4時DA水平明顯低于P組(P=0.004)。A組術(shù)后POH1時刻安靜狀態(tài)下VAS評分明顯低于P組,組間比較差異有統(tǒng)計學(xué)意義(P0.05),POH_2、POH_4、POH_6時刻VAS評分低于P組,POH_8、POH_24VAS評分高于P組,但組間比較無統(tǒng)計學(xué)意義(P0.05)。A組術(shù)后POH1、POH_2、POH_4、POH_6、POH_8時間點,運動時疼痛VAS評分均明顯低于P組,組間比較差異有統(tǒng)計學(xué)意義(P0.05),POH_24高于P組,但組間比較無統(tǒng)計學(xué)意義(P0.05)。術(shù)后兩組患者POH1、POH_2、POH_4、POH_6、POH_8、POH_24時間點Ramsay鎮(zhèn)靜評分,兩組間差異無統(tǒng)計學(xué)意義(P0.05)。兩組患者術(shù)后24小時惡心、嘔吐、PCA患者例數(shù),兩組惡心、PCIA例數(shù)間比較差異有統(tǒng)計學(xué)意義(P0.05),嘔吐例數(shù)比較無差異(P0.05)。結(jié)論:收肌管阻滯對全膝置換術(shù)后疼痛有明顯的鎮(zhèn)痛效果,較單純PCIA能更好的抑制應(yīng)激反應(yīng),且復(fù)合PCIA可減少阿片類藥物的用量和副作用。
[Abstract]:Objective: to observe the analgesic effect of adductor canal block after total knee arthroplasty (TKA), and to explore the effectiveness and feasibility of adductor canal block in postoperative analgesia after total knee arthroplasty. Methods: forty patients with selective total knee replacement from September 2015 to February 2016 were randomly divided into two groups: adductor muscle tube block combined with PCEA group (ACB PCIAA group A) and patient controlled intravenous analgesia group (20 cases in each group). Both groups were operated on under general anesthesia. Group A was treated with ultrasound guided adductor catheter puncture block before general anesthesia, and 0.5% ropivacaine was injected into adductor muscle canal. PCIAA was performed only in group A after operation. Blood samples were collected from the internal jugular vein at the same time. The concentrations of epinephrine nebula, norepinephrinene, dopamine were measured by radioimmunoassay. Two hours after ropivacaine injection, the visual analogue scaleVAS score (visual analogue scaleVAS score) and the PCIA side effect were recorded. Results: the level of blood glucose in both groups at T4 was significantly higher than that in T1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 The level of E in both groups was significantly lower than that in group T _ (1) / T _ (4) and P _ (0.05) / T _ (4) in group A was significantly lower than that in group P (P = 0.029). The NE level in both groups was significantly higher than that in T _ 1 + T _ 2T _ 2T _ (3) + P _ (0.05) T _ (3) group. The NE level in group A was significantly lower than that in group P (P 0.001). The DA level in group T _ (4) was significantly higher than that in group T _ (4). The level of DA in group A was significantly lower than that in group P (P _ (0.004) 4). The VAS score in group A was significantly lower than that in group P in the quiet state of POH1 after operation, and the level of DA in group T _ 4 was significantly higher than that in group T _ (1) and T _ (2) T _ (3). There was a significant difference between the two groups. The VAS score was lower than that in P group (P < 0.05), but there was no significant difference between the two groups (P _ (0.05) P _ (0.05) and P _ (0.05) / P _ (0.05). The VAS scores of pain were significantly lower in P group than in P group (P < 0.05). The scores of VAS were significantly lower in group P than in group P at the same time point after operation, but there was no significant difference between the two groups in the number of POH1POH2POH2POH4POH6POH6POH8. The difference between the two groups was statistically significant (P 0.05) and POH24 was higher than that of P group (P 0.05), but there was no significant difference between the two groups (P 0.05). There was no significant difference in Ramsay sedation score between the two groups at 24 hours after operation. There was no significant difference between the two groups. The number of PCA patients with nausea and vomiting 24 hours after operation was significantly different between the two groups (P 0.05), but there was no significant difference in the number of vomiting cases (P 0.05). Conclusion: adductor tube block has obvious analgesic effect on pain after total knee replacement, which can inhibit stress response better than PCIA alone, and compound PCIA can reduce the dosage and side effect of opioid drugs.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 晏達(dá);;地佐辛復(fù)合曲馬多用于瑞芬太尼全身麻醉蘇醒期鎮(zhèn)痛效果[J];中華實用診斷與治療雜志;2012年05期

2 唐帥;徐仲煌;黃宇光;何凱;任麗英;錢文偉;翁習(xí)生;;連續(xù)股神經(jīng)阻滯和靜脈患者自控鎮(zhèn)痛對全膝關(guān)節(jié)置換術(shù)圍手術(shù)期影響的比較[J];中國醫(yī)學(xué)科學(xué)院學(xué)報;2010年05期

相關(guān)碩士學(xué)位論文 前1條

1 閆金洪;全膝關(guān)節(jié)置換（TKA）術(shù)后連續(xù)股神經(jīng)阻滯聯(lián)合關(guān)節(jié)周圍注射鎮(zhèn)痛及早期膝關(guān)節(jié)功能康復(fù)研究[D];第四軍醫(yī)大學(xué);2013年

，

本文編號：1837051