全膝置换术后超声引导下收肌管阻滞镇痛效果的研究

发布时间：2018-05-03 04:44

本文选题：全膝关节置换 + 超声　；参考：《宁波大学》2017年硕士论文

【摘要】：目的:观察全膝关节置换术(total knee arthroplasty,TKA)后超声引导下收肌管阻滞(adductor canal blockade,ACB)对手术切口的镇痛效果,拟探讨收肌管阻滞在全膝关节置换术后镇痛的有效性和可行性。方法:选择2015年9月-2016年2月我院择期全膝置换患者40例,采用随机数字表法分成收肌管阻滞联合静脉自控镇痛组(ACB+PCIA,A组))和单纯静脉自控镇痛组(patient controlled intravenous analgesia,PCIA,P组),每组20例。两组均在全麻下手术,术毕A组在未全麻苏醒前采用超声引导下收肌管穿刺阻滞,收肌管内注射0.5%罗哌卡因20mL,P组术后单纯行PCIA。检测两组患者麻醉前(T_1)、术中(T_2)、术毕(T_3)、术后24小时(T_4)血糖浓度;同时经颈内静脉采集血样,采用放射免疫法测定肾上腺素(epinephrine,E)、去甲肾上腺素(norepinephrine,NE)、多巴胺(dopamine,DA)浓度。记录两组患者罗哌卡因推注后1小时(POH1)、2小时(POH_2)、4小时(POH_4)、6小时(POH_6)、8小时(POH_8)、24小时(POH_24)静息状态和膝关节屈曲45°时疼痛视觉模拟评分(Visual analogue scale,VAS评分),Ramsay镇静评分和PCIA副反应。结果:两组T_4时血糖水平均明显高于T_1、T_2、T_3时(P0.05);A组T_4时血糖水平明显低于P组(P=0.001)。两组T_2、T_3时E水平均明显低于T_1、T_4时(P0.05);A组T_4时E水平明显低于P组(P=0.029)。两组T_4时NE水平均明显高于T_1、T_2、T_3时(P0.05);A组T_4时NE水平明显低于P组(P0.001)。P组T_4时DA水平均明显高于T_1、T_2、T_3时(P0.05);A组T_4时DA水平明显低于P组(P=0.004)。A组术后POH1时刻安静状态下VAS评分明显低于P组,组间比较差异有统计学意义(P0.05),POH_2、POH_4、POH_6时刻VAS评分低于P组,POH_8、POH_24VAS评分高于P组,但组间比较无统计学意义(P0.05)。A组术后POH1、POH_2、POH_4、POH_6、POH_8时间点,运动时疼痛VAS评分均明显低于P组,组间比较差异有统计学意义(P0.05),POH_24高于P组,但组间比较无统计学意义(P0.05)。术后两组患者POH1、POH_2、POH_4、POH_6、POH_8、POH_24时间点Ramsay镇静评分,两组间差异无统计学意义(P0.05)。两组患者术后24小时恶心、呕吐、PCA患者例数,两组恶心、PCIA例数间比较差异有统计学意义(P0.05),呕吐例数比较无差异(P0.05)。结论:收肌管阻滞对全膝置换术后疼痛有明显的镇痛效果,较单纯PCIA能更好的抑制应激反应,且复合PCIA可减少阿片类药物的用量和副作用。
[Abstract]:Objective: to observe the analgesic effect of adductor canal block after total knee arthroplasty (TKA), and to explore the effectiveness and feasibility of adductor canal block in postoperative analgesia after total knee arthroplasty. Methods: forty patients with selective total knee replacement from September 2015 to February 2016 were randomly divided into two groups: adductor muscle tube block combined with PCEA group (ACB PCIAA group A) and patient controlled intravenous analgesia group (20 cases in each group). Both groups were operated on under general anesthesia. Group A was treated with ultrasound guided adductor catheter puncture block before general anesthesia, and 0.5% ropivacaine was injected into adductor muscle canal. PCIAA was performed only in group A after operation. Blood samples were collected from the internal jugular vein at the same time. The concentrations of epinephrine nebula, norepinephrinene, dopamine were measured by radioimmunoassay. Two hours after ropivacaine injection, the visual analogue scaleVAS score (visual analogue scaleVAS score) and the PCIA side effect were recorded. Results: the level of blood glucose in both groups at T4 was significantly higher than that in T1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 2 The level of E in both groups was significantly lower than that in group T _ (1) / T _ (4) and P _ (0.05) / T _ (4) in group A was significantly lower than that in group P (P = 0.029). The NE level in both groups was significantly higher than that in T _ 1 + T _ 2T _ 2T _ (3) + P _ (0.05) T _ (3) group. The NE level in group A was significantly lower than that in group P (P 0.001). The DA level in group T _ (4) was significantly higher than that in group T _ (4). The level of DA in group A was significantly lower than that in group P (P _ (0.004) 4). The VAS score in group A was significantly lower than that in group P in the quiet state of POH1 after operation, and the level of DA in group T _ 4 was significantly higher than that in group T _ (1) and T _ (2) T _ (3). There was a significant difference between the two groups. The VAS score was lower than that in P group (P < 0.05), but there was no significant difference between the two groups (P _ (0.05) P _ (0.05) and P _ (0.05) / P _ (0.05). The VAS scores of pain were significantly lower in P group than in P group (P < 0.05). The scores of VAS were significantly lower in group P than in group P at the same time point after operation, but there was no significant difference between the two groups in the number of POH1POH2POH2POH4POH6POH6POH8. The difference between the two groups was statistically significant (P 0.05) and POH24 was higher than that of P group (P 0.05), but there was no significant difference between the two groups (P 0.05). There was no significant difference in Ramsay sedation score between the two groups at 24 hours after operation. There was no significant difference between the two groups. The number of PCA patients with nausea and vomiting 24 hours after operation was significantly different between the two groups (P 0.05), but there was no significant difference in the number of vomiting cases (P 0.05). Conclusion: adductor tube block has obvious analgesic effect on pain after total knee replacement, which can inhibit stress response better than PCIA alone, and compound PCIA can reduce the dosage and side effect of opioid drugs.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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