膝关节置换术后连续收肌管阻滞与股神经阻滞的疗效比较

发布时间：2018-04-09 19:59

本文选题：收肌管阻滞　切入点：膝关节置换　出处：《北京大学学报(医学版)》2017年01期

【摘要】：目的:比较连续收肌管阻滞(adductor canal block,ACB)与连续股神经阻滞(femoral nerve block,FNB)在全膝关节置换术后的临床效果。方法:前瞻性观察2016年4—9月因重度退行性骨关节炎行单侧、初次膝关节置换的患者,随机分为ACB组和FNB组。记录患者术后2、6、12、24、48 h静息及运动状态下运用疼痛数字分级法(numeric pain rating scales,NPRS)进行的镇痛评分、术前及术后24、48 h股四头肌肌力、术后48 h内阿片类药物追加使用量、术后不良反应等。结果:共纳入40例患者,每组各20例,男∶女=7∶33,年龄(63.8±10.1)岁,体重指数(body mass index,BMI)为(28.5±3.5)kg/m~2。两组患者在美国麻醉学会(American Society of Anesthesiologists,ASA)评分、术前畸形程度、疼痛评分、股四头肌肌力、手术时间和止血带使用时间方面差异无统计学意义。除术后2 h的静息痛[ACB=0.0(0,6),FNB=3.0(0,5),P=0.004]和术后12 h的运动痛[ACB=3.0(3,0),FNB=5.5(0,10),P=0.004)外,其他时点两组疼痛评分差异均无统计学意义(P0.05)。术后24、48 h股四头肌肌力,ACB组为(85.3±27.6)N和(82.0±30.1)N,FNB组为(69.0±29.4)N和(64.4±32.0)N,两组均随时间变化呈下降趋势,尽管具体数值ACB组高于FNB组,但组间差异无统计学意义(F=2.703,P=0.108)。术后24 h内追加使用盐酸哌替啶(100 mg/次)者,ACB组有4例,FNB组有5例;术后24~48 h内追加者,ACB组3例,FNB组2例;所有追加均为1次。ACB组中,5例患者出现术后恶心,另有1例感到口干;FNB组恶心者4例,均同时伴有呕吐,另有口干者3例,下肢肌间血栓患者2例。结论:膝关节置换术后,连续ACB的镇痛效果并不优于连续FNB,但ACB减小了对术后股四头肌力的影响,有利于术后早期活动。
[Abstract]:Objective: to compare the clinical effects of continuous adductor canal block and femoral nerve block after total knee arthroplasty.Methods: patients undergoing unilateral and primary knee arthroplasty due to severe degenerative osteoarthritis from April to September 2016 were randomly divided into ACB group and FNB group.The analgesic scores of patients with pain rating scales were recorded before and after 2448 h postoperatively and 48 h after operation. The analgesic scores of the patients were evaluated by digital pain grading method. The muscle strength of quadriceps femoris was 2448 h before and after operation, the additional use of opioid drugs within 48 h after operation, the adverse reactions after operation, and so on.Results: a total of 40 patients (20 cases in each group, male: female: 7: 33, age: 63.8 卤10.1) years old, body mass index (BMI) was 28.5 卤3.5 kg 路kg ~ (-1) 路m ~ (-1) 路min ~ (-1).There was no significant difference between the two groups in American Society of Anesthesiologists (ASA) score, preoperative deformity degree, pain score, quadriceps femoris muscle strength, operation time and tourniquet use time.Within 24 hours after operation, 4 cases were treated with pethidine hydrochloride (100 mg/), 5 cases in mg/ group, 3 cases in group A within 24 h after operation, 5 cases in group A, 5 cases in group A, 5 cases in group A, 5 cases in group A and 2 cases in group A within 24 h after operation.There were 4 cases of nausea in FNB group, 3 cases of dry mouth and 2 cases of intermuscular thrombosis of lower extremity.Conclusion: after knee arthroplasty, the analgesic effect of continuous ACB is not better than that of FNB, but ACB reduces the influence of quadriceps femoris muscle strength, which is beneficial to the early postoperative activities.
【作者单位】：北京大学第三医院骨科;北京大学第三医院麻醉科;北京大学第三医院临床流行病学研究中心;
【分类号】：R687.4

【参考文献】