發(fā)布時(shí)間：2018-08-01 10:05

【摘要】：背景:股神經(jīng)阻滯在全膝關(guān)節(jié)置換術(shù)圍手術(shù)期鎮(zhèn)痛中的有效性得到廣泛認(rèn)可,但對于聯(lián)合坐骨神經(jīng)阻滯的必要性一直存在爭議。目的:探討股神經(jīng)聯(lián)合坐骨神經(jīng)阻滯在全膝關(guān)節(jié)置換圍手術(shù)期多模式鎮(zhèn)痛中的鎮(zhèn)痛效果及對功能鍛煉的影響。方法:將150例擬行全膝關(guān)節(jié)置換的患者隨機(jī)分為3組,每組50例。全麻組術(shù)前行常規(guī)全麻;股神經(jīng)阻滯組在全麻前行術(shù)側(cè)股神經(jīng)阻滯;股神經(jīng)+坐骨神經(jīng)阻滯組在全麻前分別行術(shù)側(cè)股神經(jīng)、坐骨神經(jīng)阻滯。比較3組患者術(shù)后靜息、運(yùn)動狀態(tài)下的目測類比評分,膝關(guān)節(jié)主動活動度,術(shù)后住院天數(shù),不良反應(yīng)及復(fù)診時(shí)的膝關(guān)節(jié)HSS評分。結(jié)果與結(jié)論:(1)股神經(jīng)阻滯組、股神經(jīng)+坐骨神經(jīng)阻滯組術(shù)后各時(shí)間點(diǎn)靜息、運(yùn)動目測類比評分均顯著低于全麻組(P0.05),股神經(jīng)+坐骨神經(jīng)阻滯組顯著低于股神經(jīng)阻滯組(P0.05);(2)股神經(jīng)阻滯組、股神經(jīng)+坐骨神經(jīng)阻滯組術(shù)后各時(shí)間點(diǎn)膝關(guān)節(jié)主動活動度均顯著大于全麻組(P0.05),股神經(jīng)+坐骨神經(jīng)阻滯組顯著大于股神經(jīng)阻滯組(P0.05);(3)股神經(jīng)阻滯組、股神經(jīng)+坐骨神經(jīng)阻滯組術(shù)后住院天數(shù)均顯著少于全麻組(P0.05),股神經(jīng)+坐骨神經(jīng)阻滯組顯著少于股神經(jīng)阻滯組(P0.05);(4)術(shù)后1個(gè)月時(shí),股神經(jīng)阻滯組、股神經(jīng)+坐骨神經(jīng)阻滯組的膝關(guān)節(jié)HSS評分均顯著高于全麻組(P0.05),股神經(jīng)+坐骨神經(jīng)阻滯組顯著高于股神經(jīng)阻滯組(P0.05);術(shù)后3個(gè)月和6個(gè)月時(shí),3組間的膝關(guān)節(jié)HSS評分差異無顯著性意義(P0.05);(5)結(jié)果提示,與全麻及股神經(jīng)阻滯相比,股神經(jīng)聯(lián)合坐骨神經(jīng)阻滯在全膝置換圍手術(shù)期多模式鎮(zhèn)痛中有更好的術(shù)后鎮(zhèn)痛效果,為全膝關(guān)節(jié)置換患者術(shù)后早期功能鍛煉提供了有利條件。
[Abstract]:Background: the effectiveness of femoral nerve block in the perioperative analgesia of total knee arthroplasty is widely recognized, but the necessity of combined sciatic nerve block has been controversial. Objective: To explore the analgesic effect and functional exercise of femoral nerve block combined with sciatic nerve block in the perioperative multimode analgesia. Methods: 150 patients with total knee arthroplasty were randomly divided into 3 groups, 50 cases in each group. The general anesthesia group was performed general anesthesia before the operation; femoral nerve block group was performed the femoral nerve block before general anesthesia; femoral nerve + sciatic nerve block group was treated with the lateral femoral nerve and the sciatic deity block before general anesthesia. The 3 groups were resting after the operation, and the movement state was compared. Results and conclusions: (1) the femoral nerve block group, the femoral nerve and the sciatic nerve block group were resting at all time points after the operation, and the exercise visual analogue score was significantly lower than the general anesthesia group (P0.05), the femoral nerve + sciatic nerve block group was significant (1) Lower than the femoral nerve block group (P0.05); (2) the femoral nerve block group, the femoral nerve + sciatic nerve block group was significantly greater than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly greater than the femoral nerve block group (P0.05); (3) femoral nerve block group, femoral nerve + sciatic nerve block group after operation days after operation Significantly less than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly less than the femoral nerve block group (P0.05); (4) 1 months after the operation, the femoral nerve block group, the femoral nerve + sciatic nerve block group HSS score was significantly higher than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly higher than the femoral nerve block group (P0.05); after the operation, the group was significantly higher than the femoral nerve block group (P0.05). There was no significant difference in HSS score between the 3 groups at 3 months and 6 months (P0.05). (5) the results suggested that the femoral nerve combined with sciatic nerve block had better postoperative analgesic effect in the multimodal analgesia during total knee replacement, and provided the early functional exercise for the patients with total knee replacement. Favorable conditions.
【作者單位】： 安徽醫(yī)科大學(xué)第一附屬醫(yī)院關(guān)節(jié)與骨腫瘤外科;安徽醫(yī)科大學(xué)第一附屬醫(yī)院麻醉科;
【分類號】：R614

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