不同麻醉镇痛方式对全膝关节置换术早期效果的影响

发布时间：2018-01-30 03:16

本文关键词： 全膝关节置换术麻醉方法功能　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的目前临床上有多种麻醉镇痛方式适用于全膝关节置换。本文通过对于术后患者疼痛的程度、术后早期功能恢复好坏、不良反应的发生率等临床观察,以对比单次股-坐骨神经阻滞与硬膜外阻滞麻醉应用于全膝关节置换术效果的临床研究。方法选择我院拟行单侧全膝关节置换手术的患者60例,随机分为两组:单次股-坐骨神经阻滞神经阻滞麻醉组(A组,n=30),硬膜外阻滞麻醉组(B组,n=30)。记录全部患者的年龄(y)、性别、体重(kg)、膝关节KSS评分等一般信息。A组患者术中采用单次股-坐骨神经阻滞麻醉,B组采用硬膜外阻滞麻醉。手术由同一手术医师完成,采用相同的手术技术及相同类型的膝关节假体。采用视觉模拟评分法(Visual Analog Scale,VAS),分别记录术后6h(T1)、12h(T2)、24h(T3)、48h(T4)、72h(T5)、96h(T6)时间点的静息痛评分。术后48h时拔除引流管,同时进行膝关节功能锻炼,并记录术后48h(T4)、72h(T6)、96h(T6)时间点持续被动功能锻炼(Continuous Passive Movement,CPM)下的VAS评分及不产生重度疼痛(VAS评分7分)膝关节主动屈曲所达到最大角度。记录两组患者手术侧膝关节主动屈曲达到90°、手术侧主动直腿抬高抬离床面大于10cm所需要的时间以及患者术后住院天数。记录患者头晕、恶心、呕吐等药物相关不良反应及穿刺点疼痛、尿储留等其他并发症情况。结果A组患者术后静息VAS评分在各时间点均低于B组,其中T1、T2、T3时间点差异有统计学意义(P0.05),T4、T5、T6时间点静息VAS评分差异无统计学意义(P0.05);术后A组各时间点运动状态下VAS评分明显低于B组,两组差异有统计学意义(P0.05);术后A组各时间点膝关节主动屈曲角度均高于B组,差异有统计学意义(P0.05);术后A组患者屈曲≥90°时间、直腿抬高≥10cm及术后住院时间均低于B组(P0.05)。B组患者发生穿刺点疼痛及尿潴留的例数多于A组(P0.05),其它不良反应无明显差别。结论单次股-坐骨神经阻滞麻醉与硬膜外麻醉都可保证手术顺利完成,但单次股-坐骨神经阻滞神经阻滞麻醉可获得更佳的术后早期静息痛及运动痛的镇痛效果,有利于行单侧人工全膝关节置换术患者的早期功能锻炼及肢体功能恢复,同时减少患者住院时间,有利于提高患者满意度。
[Abstract]:Objective there are many kinds of anaesthesia and analgesia methods for total knee arthroplasty. This article makes a clinical observation on the degree of postoperative pain, the early recovery of function and the incidence of adverse reactions. Objective to compare the effect of single femoral sciatic nerve block and epidural block on total knee arthroplasty. Methods 60 patients with unilateral total knee arthroplasty were selected in our hospital. The patients were randomly divided into two groups: group A with single femoral and sciatic nerve block and group B with epidural block. The age and sex of all patients were recorded. Group A received single femoral and sciatic nerve block anesthesia and group B was anesthetized by epidural block. The operation was performed by the same surgeon. Visual Analog scale scale VASA was performed with the same surgical technique and the same type of knee prosthesis. The resting pain score at the time point of 12h T _ 2 / T _ 2 / T _ 3 / T _ 3 / T _ 4 / 72h / T _ 5 / 96 h / T _ 6). The drainage tube was removed 48 hours after operation. At the same time, the knee joint function exercise was performed, and the 72h T6 was recorded at 48h after operation. 96 h ~ (6) continuous Passive Movement. The maximal angle of active flexion of knee joint was obtained by VAS score and no severe pain and VAS score of 7). The active flexion of knee joint in both groups was recorded to be 90 掳. The time needed to raise the bed surface more than 10cm and the days of hospitalization after operation were recorded. Adverse drug reactions such as dizziness nausea vomiting and pain at puncture point were recorded. Results the resting VAS score of group A was lower than that of group B at each time point, and the difference of T _ 1 T _ 2 and T _ 3 was statistically significant (P < 0.05). There was no significant difference in resting VAS score between T5 and T6 time points (P 0.05). The VAS score of group A was significantly lower than that of group B at each time point after operation, and the difference between the two groups was statistically significant (P 0.05). The active flexion angle of knee joint in group A was higher than that in group B at each time point, and the difference was statistically significant (P 0.05). The flexion time of group A was more than 90 掳. The incidence of puncture point pain and urinary retention in group B was lower than that in group A (P 0.05). Conclusion single femoral and sciatic nerve block anesthesia and epidural anesthesia can ensure the successful completion of the operation. But single femoral and sciatic nerve block anesthesia can obtain better analgesic effect of early postoperative resting pain and motor pain. It is beneficial to the early functional exercise and limb function recovery of patients undergoing unilateral total knee arthroplasty and to reducing the hospitalization time and improving the patients' satisfaction.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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