股神经-坐骨神经联合阻滞在全膝关节置换术中对止血带反应及术后疼痛的影响

发布时间：2018-07-05 10:59

本文选题：全膝关节置换术 + 股神经-坐骨神经联合阻滞　；参考：《中国医学科学院学报》2015年06期

【摘要】：目的观察全膝关节置换术中应用股神经-坐骨神经联合阻滞对术中止血带反应、镇静镇痛药用量及术后疼痛的影响。方法选择全膝置换术患者60例,采用随机数字表的方法分成股神经阻滞组(F组)和股神经-坐骨神经联合阻滞组(SF组),每组30例。记录使用止血带充气即刻(T1)、充气后30 min(T2)、60 min(T3)、90 min(T4)、松止血带时(T5)及拔管后(T6)各组患者平均动脉压、心率变化情况;计算术中麻醉药丙泊酚、瑞芬太尼药的累计用量;记录拔管后疼痛评分及疼痛部位。结果 SF组T1~T6平均动脉压、心率差异均无统计学意义(P均0.05)。与SF组相比,F组平均动脉压T2~T4及T6明显升高(P均0.05),心率于T4及T6时明显升高(P均0.05)。与F组相比,SF组术中用丙泊酚及瑞芬太尼明显减少(P均0.05),SF组静息及运动疼痛评分均明显降低(P0.05),F组90%患者诉乆窝后侧痛。结论股神经-坐骨神经联合阻滞应用于全膝关节置换术,能明显抑制止血带反应,血流动力学稳定,减少麻醉药物用量,同时有效缓解术后疼痛。
[Abstract]:Objective To observe the effect of combined femoral nerve and sciatic nerve block on intraoperative tourniquet reaction, dosage of sedative analgesics and postoperative pain during total knee arthroplasty. Methods 60 patients with total knee replacement were selected and divided into femoral nerve block group (group F) and femoral nerve sciatic nerve block group (group SF) by random digital table. Group 30 cases, recorded the use of tourniquet inflated immediately (T1), 30 min (T2), 60 min (T3), 90 min (T4), loose tourniquet (T5) and after extubation (T6) of the average arterial pressure, heart rate changes, the calculation of anesthetic propofol, remifentanil, the cumulative dosage of remifentanil; record after extubation pain score and pain site. Results SF T1~T6 average. Results SF T1~T6 mean The difference of arterial pressure and heart rate was not statistically significant (P 0.05). Compared with group SF, the mean arterial pressure T2~T4 and T6 increased significantly in group F (P 0.05), heart rate was significantly increased at T4 and T6 (P 0.05). Compared with the F group, the propofol and remifentanil were significantly reduced during the SF group (P are 0.05), and the resting and motor pain scores in the group were significantly lower. 90 Conclusion the combination of femoral nerve and sciatic nerve block in total knee replacement can obviously inhibit the tourniquet reaction, the hemodynamics is stable, the dosage of narcotic drugs can be reduced, and the postoperative pain can be relieved.
【作者单位】：西安交通大学医学院附属红会医院麻醉科;西安交通大学医学院附属红会医院关节科;
【分类号】：R614.4

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