發(fā)布時間：2018-01-30 03:16

  本文關(guān)鍵詞： 全膝關(guān)節(jié)置換術(shù) 麻醉方法 功能　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的目前臨床上有多種麻醉鎮(zhèn)痛方式適用于全膝關(guān)節(jié)置換。本文通過對于術(shù)后患者疼痛的程度、術(shù)后早期功能恢復(fù)好壞、不良反應(yīng)的發(fā)生率等臨床觀察,以對比單次股-坐骨神經(jīng)阻滯與硬膜外阻滯麻醉應(yīng)用于全膝關(guān)節(jié)置換術(shù)效果的臨床研究。方法選擇我院擬行單側(cè)全膝關(guān)節(jié)置換手術(shù)的患者60例,隨機分為兩組:單次股-坐骨神經(jīng)阻滯神經(jīng)阻滯麻醉組(A組,n=30),硬膜外阻滯麻醉組(B組,n=30)。記錄全部患者的年齡(y)、性別、體重(kg)、膝關(guān)節(jié)KSS評分等一般信息。A組患者術(shù)中采用單次股-坐骨神經(jīng)阻滯麻醉,B組采用硬膜外阻滯麻醉。手術(shù)由同一手術(shù)醫(yī)師完成,采用相同的手術(shù)技術(shù)及相同類型的膝關(guān)節(jié)假體。采用視覺模擬評分法(Visual Analog Scale,VAS),分別記錄術(shù)后6h(T1)、12h(T2)、24h(T3)、48h(T4)、72h(T5)、96h(T6)時間點的靜息痛評分。術(shù)后48h時拔除引流管,同時進行膝關(guān)節(jié)功能鍛煉,并記錄術(shù)后48h(T4)、72h(T6)、96h(T6)時間點持續(xù)被動功能鍛煉(Continuous Passive Movement,CPM)下的VAS評分及不產(chǎn)生重度疼痛(VAS評分7分)膝關(guān)節(jié)主動屈曲所達到最大角度。記錄兩組患者手術(shù)側(cè)膝關(guān)節(jié)主動屈曲達到90°、手術(shù)側(cè)主動直腿抬高抬離床面大于10cm所需要的時間以及患者術(shù)后住院天數(shù)。記錄患者頭暈、惡心、嘔吐等藥物相關(guān)不良反應(yīng)及穿刺點疼痛、尿儲留等其他并發(fā)癥情況。結(jié)果A組患者術(shù)后靜息VAS評分在各時間點均低于B組,其中T1、T2、T3時間點差異有統(tǒng)計學(xué)意義(P0.05),T4、T5、T6時間點靜息VAS評分差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后A組各時間點運動狀態(tài)下VAS評分明顯低于B組,兩組差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后A組各時間點膝關(guān)節(jié)主動屈曲角度均高于B組,差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后A組患者屈曲≥90°時間、直腿抬高≥10cm及術(shù)后住院時間均低于B組(P0.05)。B組患者發(fā)生穿刺點疼痛及尿潴留的例數(shù)多于A組(P0.05),其它不良反應(yīng)無明顯差別。結(jié)論單次股-坐骨神經(jīng)阻滯麻醉與硬膜外麻醉都可保證手術(shù)順利完成,但單次股-坐骨神經(jīng)阻滯神經(jīng)阻滯麻醉可獲得更佳的術(shù)后早期靜息痛及運動痛的鎮(zhèn)痛效果,有利于行單側(cè)人工全膝關(guān)節(jié)置換術(shù)患者的早期功能鍛煉及肢體功能恢復(fù),同時減少患者住院時間,有利于提高患者滿意度。
[Abstract]:Objective there are many kinds of anaesthesia and analgesia methods for total knee arthroplasty. This article makes a clinical observation on the degree of postoperative pain, the early recovery of function and the incidence of adverse reactions. Objective to compare the effect of single femoral sciatic nerve block and epidural block on total knee arthroplasty. Methods 60 patients with unilateral total knee arthroplasty were selected in our hospital. The patients were randomly divided into two groups: group A with single femoral and sciatic nerve block and group B with epidural block. The age and sex of all patients were recorded. Group A received single femoral and sciatic nerve block anesthesia and group B was anesthetized by epidural block. The operation was performed by the same surgeon. Visual Analog scale scale VASA was performed with the same surgical technique and the same type of knee prosthesis. The resting pain score at the time point of 12h T _ 2 / T _ 2 / T _ 3 / T _ 3 / T _ 4 / 72h / T _ 5 / 96 h / T _ 6). The drainage tube was removed 48 hours after operation. At the same time, the knee joint function exercise was performed, and the 72h T6 was recorded at 48h after operation. 96 h ~ (6) continuous Passive Movement. The maximal angle of active flexion of knee joint was obtained by VAS score and no severe pain and VAS score of 7). The active flexion of knee joint in both groups was recorded to be 90 擄. The time needed to raise the bed surface more than 10cm and the days of hospitalization after operation were recorded. Adverse drug reactions such as dizziness nausea vomiting and pain at puncture point were recorded. Results the resting VAS score of group A was lower than that of group B at each time point, and the difference of T _ 1 T _ 2 and T _ 3 was statistically significant (P < 0.05). There was no significant difference in resting VAS score between T5 and T6 time points (P 0.05). The VAS score of group A was significantly lower than that of group B at each time point after operation, and the difference between the two groups was statistically significant (P 0.05). The active flexion angle of knee joint in group A was higher than that in group B at each time point, and the difference was statistically significant (P 0.05). The flexion time of group A was more than 90 擄. The incidence of puncture point pain and urinary retention in group B was lower than that in group A (P 0.05). Conclusion single femoral and sciatic nerve block anesthesia and epidural anesthesia can ensure the successful completion of the operation. But single femoral and sciatic nerve block anesthesia can obtain better analgesic effect of early postoperative resting pain and motor pain. It is beneficial to the early functional exercise and limb function recovery of patients undergoing unilateral total knee arthroplasty and to reducing the hospitalization time and improving the patients' satisfaction.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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