本文選題：全膝關節(jié)置換術 + 股神經(jīng)-坐骨神經(jīng)聯(lián)合阻滯　； 參考：《中國醫(yī)學科學院學報》2015年06期

【摘要】：目的觀察全膝關節(jié)置換術中應用股神經(jīng)-坐骨神經(jīng)聯(lián)合阻滯對術中止血帶反應、鎮(zhèn)靜鎮(zhèn)痛藥用量及術后疼痛的影響。方法選擇全膝置換術患者60例,采用隨機數(shù)字表的方法分成股神經(jīng)阻滯組(F組)和股神經(jīng)-坐骨神經(jīng)聯(lián)合阻滯組(SF組),每組30例。記錄使用止血帶充氣即刻(T1)、充氣后30 min(T2)、60 min(T3)、90 min(T4)、松止血帶時(T5)及拔管后(T6)各組患者平均動脈壓、心率變化情況;計算術中麻醉藥丙泊酚、瑞芬太尼藥的累計用量;記錄拔管后疼痛評分及疼痛部位。結(jié)果 SF組T1~T6平均動脈壓、心率差異均無統(tǒng)計學意義(P均0.05)。與SF組相比,F組平均動脈壓T2~T4及T6明顯升高(P均0.05),心率于T4及T6時明顯升高(P均0.05)。與F組相比,SF組術中用丙泊酚及瑞芬太尼明顯減少(P均0.05),SF組靜息及運動疼痛評分均明顯降低(P0.05),F組90%患者訴乆窩后側(cè)痛。結(jié)論股神經(jīng)-坐骨神經(jīng)聯(lián)合阻滯應用于全膝關節(jié)置換術,能明顯抑制止血帶反應,血流動力學穩(wěn)定,減少麻醉藥物用量,同時有效緩解術后疼痛。
[Abstract]:Objective To observe the effect of combined femoral nerve and sciatic nerve block on intraoperative tourniquet reaction, dosage of sedative analgesics and postoperative pain during total knee arthroplasty. Methods 60 patients with total knee replacement were selected and divided into femoral nerve block group (group F) and femoral nerve sciatic nerve block group (group SF) by random digital table. Group 30 cases, recorded the use of tourniquet inflated immediately (T1), 30 min (T2), 60 min (T3), 90 min (T4), loose tourniquet (T5) and after extubation (T6) of the average arterial pressure, heart rate changes, the calculation of anesthetic propofol, remifentanil, the cumulative dosage of remifentanil; record after extubation pain score and pain site. Results SF T1~T6 average. Results SF T1~T6 mean The difference of arterial pressure and heart rate was not statistically significant (P 0.05). Compared with group SF, the mean arterial pressure T2~T4 and T6 increased significantly in group F (P 0.05), heart rate was significantly increased at T4 and T6 (P 0.05). Compared with the F group, the propofol and remifentanil were significantly reduced during the SF group (P are 0.05), and the resting and motor pain scores in the group were significantly lower. 90 Conclusion the combination of femoral nerve and sciatic nerve block in total knee replacement can obviously inhibit the tourniquet reaction, the hemodynamics is stable, the dosage of narcotic drugs can be reduced, and the postoperative pain can be relieved.
【作者單位】： 西安交通大學醫(yī)學院附屬紅會醫(yī)院麻醉科;西安交通大學醫(yī)學院附屬紅會醫(yī)院關節(jié)科;
【分類號】：R614.4

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