發(fā)布時間：2018-05-01 02:11

  本文選題：人工全膝關節(jié)置換術 + 神經傳導阻滯�。� 參考：《中國修復重建外科雜志》2017年09期

【摘要】：目的探討多模式鎮(zhèn)痛下置管持續(xù)收肌管阻滯(adductor canal block,ACB)與單次注射ACB對人工全膝關節(jié)置換術(total knee arthroplasty,TKA)后鎮(zhèn)痛及早期康復的影響。方法 2016年10月—2017年2月,將60例因重度退行性骨關節(jié)炎擬行初次單膝TKA且符合選擇標準的患者納入研究,隨機分為置管持續(xù)ACB組(A組)和單次注射ACB組(B組),每組30例。兩組患者性別、年齡、體質量指數(shù)、民族、美國麻醉醫(yī)師協(xié)會(ASA)分級以及術前膝關節(jié)活動度、股四頭肌肌力等一般資料比較,差異均無統(tǒng)計學意義(P0.05),具有可比性。記錄兩組術中使用止血帶時間、術后引流量、術后住院時間、鹽酸哌替啶使用情況、不良反應事件發(fā)生情況。術后行靜息及活動時疼痛視覺模擬評分(VAS),采用徒手肌力法評定股四頭肌肌力,測量膝關節(jié)活動度并記錄首次屈膝達90°時間。結果 A組術中使用止血帶時間、術后引流量、不良反應發(fā)生率與B組比較,差異均無統(tǒng)計學意義(P0.05);但A組術后住院時間較B組明顯縮短(P0.05)。術后各時間點A組VAS評分均低于B組,其中術后12 h后靜息VAS評分及8 h后活動VAS評分與B組比較,差異均有統(tǒng)計學意義(P0.05)。術后各時間點A組股四頭肌肌力均優(yōu)于B組,其中術后24、48、72 h組間比較差異有統(tǒng)計學意義(P0.05)。A組術后24、48、72 h及出院當天膝關節(jié)活動度均顯著優(yōu)于B組(P0.05),患者首次屈膝達90°時間較B組明顯縮短(t= 2.951,P=0.016)。術后24 h內使用鹽酸哌替啶(50 mg/次)者,A組4例、B組7例;術后24~48 h使用,A組3例、B組7例;術后48~72 h使用,A組1例、B組3例。A組2例發(fā)生置管處滲液,無1例發(fā)生置管脫落。結論置管持續(xù)ACB對TKA術后靜息及活動狀態(tài)下的鎮(zhèn)痛效果均優(yōu)于單次注射ACB,能明顯降低阿片類藥物使用量,更有利于患者股四頭肌肌力恢復,促進早期功能康復。
[Abstract]:Objective to investigate the effect of continuous adductor canal block under multi-mode analgesia and single injection of ACB on analgesia and early recovery after total knee arthroplasty. Methods from October 2016 to February 2017, 60 patients with severe degenerative osteoarthritis were randomly divided into two groups: group A (n = 30) and group B (n = 30). There were no significant differences in sex, age, body mass index, nationality, ASA-grade, preoperative knee motion and quadriceps muscle strength between the two groups, and there was no significant difference between the two groups (P 0.05). The time of tourniquet use, postoperative drainage, postoperative hospital stay, pethidine hydrochloride use and adverse events were recorded in both groups. The visual analogue score of pain during rest and exercise was performed after operation. The quadriceps femoris muscle strength was assessed by the method of free hand muscle strength. The knee motion was measured and the first time of knee flexion reached 90 擄. Results there was no significant difference between group A and group B in using tourniquet time, postoperative drainage and adverse reactions, but the postoperative hospitalization time in group A was significantly shorter than that in group B (P 0.05). The scores of VAS in group A were lower than those in group B at all time points, and there were significant differences between group B and group B in resting VAS score 12 h after operation and activity VAS score 8 h after operation (P 0.05). The muscle strength of quadriceps femoris in group A was better than that in group B at each time point after operation. There was significant difference between the two groups at 24: 48 and 72 h after operation. The motion of the knee joint in group A was significantly better than that in group B at 2448 hours after operation. The first time of knee flexion reached 90 擄in group B was significantly shorter than that in group B (P = 2.951) and the time of first flexion was significantly shorter than that in group B (P = 2.951). In group A, 7 cases were treated with pethidine hydrochloride 50 mg/ within 24 h after operation, 7 cases in group B were treated with pethidine hydrochloride at 2448 h after operation, 7 cases in group B were treated with meperidine hydrochloride at 2448 h after operation, 3 cases in group A and 1 case in group A at 4872 h after operation, 3 cases in group B, 3 cases in group A and 2 cases in group A. Conclusion the analgesic effect of continuous catheterization with ACB is better than that of single injection of TKA in resting and active state. It can significantly reduce the use of opioid drugs and is more beneficial to the recovery of quadriceps femoris muscle strength and early functional rehabilitation.
【作者單位】： 四川大學華西醫(yī)院骨科;四川大學華西醫(yī)院麻醉科;
【基金】：衛(wèi)生行業(yè)科研專項項目(201302007)~~
【分類號】：R687.4

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