本文選題：膝關節(jié)置換術 + 收肌管阻滯��； 參考：《山東醫(yī)藥》2017年21期

【摘要】：目的評價超聲引導下收肌管阻滯(ACB)在全膝關節(jié)置換術后多模式聯(lián)合鎮(zhèn)痛中的作用。方法選擇擇期行初次單側膝關節(jié)置換術的患者60例,隨機分為A、B組各30例。術中均采用喉罩全憑靜脈全麻,A組在麻醉誘導前行超聲引導下ACB,阻滯成功后注射0.5%羅哌卡因20 m L;B組不行神經(jīng)阻滯。記錄術后靜態(tài)和動態(tài)視覺模擬評分法(VAS)、術后48 h內鎮(zhèn)痛泵有效按壓次數(shù)、嗎啡補救鎮(zhèn)痛用量及手術前后患肢股四頭肌肌力Lovett評分、運動阻滯改良Bromage評分;記錄術后24、48、72 h、出院時患肢膝關節(jié)最大主動活動,術后第1次下床活動時間和第1次主動直腿抬高時間;統(tǒng)計鎮(zhèn)痛相關不良反應發(fā)生率。結果 A組術后靜態(tài)和動態(tài)VAS、術后48 h內鎮(zhèn)痛泵按壓次數(shù),嗎啡補救鎮(zhèn)痛用量,術后24、48、72 h、出院時膝關節(jié)最大主動活動度,術后第1次下床活動時間和第1次主動直腿抬高時間,惡心嘔吐、皮膚瘙癢、頭暈發(fā)生率與B組比較,P均0.05。結論在全膝關節(jié)置換采用ACB為主的多模式聯(lián)合鎮(zhèn)痛方案,術后鎮(zhèn)痛效果佳,運動阻滯輕微,不良反應發(fā)生率低。
[Abstract]:Objective to evaluate the effect of ultrasound-guided adductor catheter block (ACBs) on multi-mode combined analgesia after total knee arthroplasty. Methods 60 patients with primary unilateral knee arthroplasty were randomly divided into group A (n = 30) and group B (n = 30). All patients were treated with laryngeal mask total intravenous general anesthesia group A under ultrasonic guidance before anesthesia induction. After successful anesthesia, 0.5% ropivacaine was injected into group B and no nerve block was achieved. Visual analogue scores of static and dynamic postoperatively were recorded. The effective times of analgesia pump, the amount of morphine analgesia, the Lovett score of quadriceps femoris muscle strength before and after operation and the modified Bromage score of motor block were recorded within 48 hours after operation. The maximal active movement of knee joint was recorded at 24 minutes and 48 minutes 72 hours after discharge, the first time of getting out of bed and the first time of active straight leg elevation were recorded, and the incidence of adverse reactions related to analgesia was counted. Results in group A, the postoperative static and dynamic VASs, the number of analgesic pump compressions within 48 hours after operation, the amount of morphine relief analgesia, the maximum active movement of the knee joint at the time of discharge, the first time of getting out of bed and the first time of active straight leg raising were observed in group A. The incidence of nausea and vomiting, pruritus and dizziness in group B were 0.05. Conclusion in total knee arthroplasty, combined analgesia with ACB is effective, motor block is mild and adverse reaction rate is low.
【作者單位】： 濟寧市第一人民醫(yī)院;
【基金】：濟寧市科技發(fā)展計劃醫(yī)藥衛(wèi)生項目(2015-57-07)
【分類號】：R614

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