置管持续收肌管阻滞与单次注射收肌管阻滞对人工全膝关节置换术后镇痛及早期康复的影响研究

发布时间：2018-05-01 02:11

本文选题：人工全膝关节置换术 + 神经传导阻滞　；参考：《中国修复重建外科杂志》2017年09期

【摘要】：目的探讨多模式镇痛下置管持续收肌管阻滞(adductor canal block,ACB)与单次注射ACB对人工全膝关节置换术(total knee arthroplasty,TKA)后镇痛及早期康复的影响。方法 2016年10月—2017年2月,将60例因重度退行性骨关节炎拟行初次单膝TKA且符合选择标准的患者纳入研究,随机分为置管持续ACB组(A组)和单次注射ACB组(B组),每组30例。两组患者性别、年龄、体质量指数、民族、美国麻醉医师协会(ASA)分级以及术前膝关节活动度、股四头肌肌力等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组术中使用止血带时间、术后引流量、术后住院时间、盐酸哌替啶使用情况、不良反应事件发生情况。术后行静息及活动时疼痛视觉模拟评分(VAS),采用徒手肌力法评定股四头肌肌力,测量膝关节活动度并记录首次屈膝达90°时间。结果 A组术中使用止血带时间、术后引流量、不良反应发生率与B组比较,差异均无统计学意义(P0.05);但A组术后住院时间较B组明显缩短(P0.05)。术后各时间点A组VAS评分均低于B组,其中术后12 h后静息VAS评分及8 h后活动VAS评分与B组比较,差异均有统计学意义(P0.05)。术后各时间点A组股四头肌肌力均优于B组,其中术后24、48、72 h组间比较差异有统计学意义(P0.05)。A组术后24、48、72 h及出院当天膝关节活动度均显著优于B组(P0.05),患者首次屈膝达90°时间较B组明显缩短(t= 2.951,P=0.016)。术后24 h内使用盐酸哌替啶(50 mg/次)者,A组4例、B组7例;术后24~48 h使用,A组3例、B组7例;术后48~72 h使用,A组1例、B组3例。A组2例发生置管处渗液,无1例发生置管脱落。结论置管持续ACB对TKA术后静息及活动状态下的镇痛效果均优于单次注射ACB,能明显降低阿片类药物使用量,更有利于患者股四头肌肌力恢复,促进早期功能康复。
[Abstract]:Objective to investigate the effect of continuous adductor canal block under multi-mode analgesia and single injection of ACB on analgesia and early recovery after total knee arthroplasty. Methods from October 2016 to February 2017, 60 patients with severe degenerative osteoarthritis were randomly divided into two groups: group A (n = 30) and group B (n = 30). There were no significant differences in sex, age, body mass index, nationality, ASA-grade, preoperative knee motion and quadriceps muscle strength between the two groups, and there was no significant difference between the two groups (P 0.05). The time of tourniquet use, postoperative drainage, postoperative hospital stay, pethidine hydrochloride use and adverse events were recorded in both groups. The visual analogue score of pain during rest and exercise was performed after operation. The quadriceps femoris muscle strength was assessed by the method of free hand muscle strength. The knee motion was measured and the first time of knee flexion reached 90 掳. Results there was no significant difference between group A and group B in using tourniquet time, postoperative drainage and adverse reactions, but the postoperative hospitalization time in group A was significantly shorter than that in group B (P 0.05). The scores of VAS in group A were lower than those in group B at all time points, and there were significant differences between group B and group B in resting VAS score 12 h after operation and activity VAS score 8 h after operation (P 0.05). The muscle strength of quadriceps femoris in group A was better than that in group B at each time point after operation. There was significant difference between the two groups at 24: 48 and 72 h after operation. The motion of the knee joint in group A was significantly better than that in group B at 2448 hours after operation. The first time of knee flexion reached 90 掳in group B was significantly shorter than that in group B (P = 2.951) and the time of first flexion was significantly shorter than that in group B (P = 2.951). In group A, 7 cases were treated with pethidine hydrochloride 50 mg/ within 24 h after operation, 7 cases in group B were treated with pethidine hydrochloride at 2448 h after operation, 7 cases in group B were treated with meperidine hydrochloride at 2448 h after operation, 3 cases in group A and 1 case in group A at 4872 h after operation, 3 cases in group B, 3 cases in group A and 2 cases in group A. Conclusion the analgesic effect of continuous catheterization with ACB is better than that of single injection of TKA in resting and active state. It can significantly reduce the use of opioid drugs and is more beneficial to the recovery of quadriceps femoris muscle strength and early functional rehabilitation.
【作者单位】：四川大学华西医院骨科;四川大学华西医院麻醉科;
【基金】：卫生行业科研专项项目(201302007)~~
【分类号】：R687.4

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