【摘要】：目的:比較超聲導(dǎo)航下縫匠肌下入路連續(xù)隱神經(jīng)阻滯與腹股溝入路連續(xù)股神經(jīng)阻滯分別應(yīng)用于人工全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)術(shù)后鎮(zhèn)痛對術(shù)后康復(fù)質(zhì)量的影響。方法:根據(jù)試驗所定入選標(biāo)準(zhǔn)以及排除標(biāo)準(zhǔn)選擇擇期在我院腰麻下行人工單側(cè)全膝關(guān)節(jié)置換術(shù)患者50例,隨機將患者分為觀察組連續(xù)縫匠肌下入路隱神經(jīng)阻滯鎮(zhèn)痛S組和對照組連續(xù)腹股溝入路股神經(jīng)阻滯鎮(zhèn)痛F組,每組25例�；颊叱Ｒ�(guī)入室后建立外周靜脈,以8-10ml/kg外周靜脈輸注鈉鉀鎂葡萄糖注射液(樂加),隨后以5-10ml/kg/h的速度維持輸液,術(shù)中根據(jù)出血量以及手術(shù)時間控制輸液總量。S組患者行單次腰麻平面固定后在超聲導(dǎo)航下縫匠肌下入路收肌管隱神經(jīng)旁留置導(dǎo)管,F組患者行單次腰麻平面固定后在超聲導(dǎo)航下腹股溝入路股神經(jīng)旁留置導(dǎo)管。兩組患者腰麻皆選擇L3-4間隙穿刺,注射局麻藥物時針尖斜面朝向尾側(cè),注藥速度1ml/5s,局麻藥物選擇1%鹽酸羅哌卡因2ml+0.9%NS1ml混合液共3ml。兩組患者均在腰麻完成后用酒精擦拭法確定麻醉效果,將麻醉平面控制在T8以下。手術(shù)結(jié)束前20分鐘兩組患者皆通過留置導(dǎo)管在外周神經(jīng)旁推注0.25%羅哌卡因15ml負(fù)荷量,然后連接一次性便攜式輸注系統(tǒng)。輸注泵內(nèi)藥物成份為1%鹽酸羅哌卡因40ml+地阿塞米松5mg+0.9%生理鹽水120ml,總量為160ml,為48小時用量,48小時后按同樣比例重新配置局麻鎮(zhèn)痛藥一次(模式輸注泵背景劑量3ml/h,患者自控量4ml/h,鎖定間隔時間為15分鐘)。術(shù)后康復(fù)過程中通過觀察并記錄兩組患者不同觀察點的阿片類藥物使用總量、睡眠中斷次數(shù)、靜息以及運動疼痛評分、股四頭肌肌力、膝關(guān)節(jié)活動度、步行距離、血漿IL-6、C反應(yīng)蛋白以及術(shù)后血糖水平來評價康復(fù)質(zhì)量。結(jié)果:我們對參與并完成實驗的50例患者進行了統(tǒng)計學(xué)分析。兩組患者在年齡、體重、性別、手術(shù)時間、術(shù)前股四頭肌肌力、術(shù)前血漿CRP、IL-6,住院時間上的差異無統(tǒng)計學(xué)意義(P0.05)。S組患者在術(shù)后24h阿片類鎮(zhèn)痛藥物使用量、48h內(nèi)睡眠中斷次數(shù)、術(shù)后各觀察點靜息VAS與F組比較,也無顯著性差異(P0.05)。術(shù)后4-72h各觀察點股四頭肌肌力、被動與主動關(guān)節(jié)活動度以及CPM肌訓(xùn)練時VAS評分、步行距離,患者術(shù)后血漿應(yīng)激反應(yīng)指標(biāo)(IL-6,GLU,CRP)等兩組比較,S組明顯優(yōu)于F組(P0.05)。結(jié)論:對于人工膝關(guān)節(jié)置換(TKA)患者來說,超聲引導(dǎo)縫匠肌下入路連續(xù)隱神經(jīng)阻滯能夠更確切地提高術(shù)后康復(fù)質(zhì)量。與目前常用的持續(xù)股神經(jīng)阻滯相比,鎮(zhèn)痛效果相當(dāng),股四頭肌肌力影響小,應(yīng)激反應(yīng)更輕,術(shù)后康復(fù)鍛煉舒適度更高。
[Abstract]:Objective: to compare the effects of continuous occlusal nerve block via subsartorius muscle approach under ultrasound navigation and continuous thigh nerve block via inguinal approach on postoperative rehabilitation quality of total knee arthroplasty (total knee arthroplasty,TKA). Methods: according to the selection criteria and exclusion criteria, 50 patients undergoing artificial unilateral total knee arthroplasty under lumbar anesthesia in our hospital were randomly divided into observation group (n = 25) and control group (n = 25). After routine entry, the peripheral veins were established and sodium, potassium, magnesium, glucose injection (Lega) was infused intravenously with 8-10ml/kg, and then the infusion was maintained at the speed of 5-10ml/kg/h. The total amount of infusion was controlled according to the amount of bleeding and the operation time. The patients in group S were treated with single lumbar anesthesia plane fixation and indwelling catheter of adductor tunnel by ultrasonic navigation inferior sartorius muscle approach. In group F, patients were treated with single lumbar anesthesia plane fixation and indwelling catheter by inguinal approach under ultrasound navigation. L3 鈮，

本文編號：2506959