超声引导下收肌管阻滞在全膝关节置换术后多模式联合镇痛中的作用

发布时间：2018-06-15 19:30

本文选题：膝关节置换术 + 收肌管阻滞　；参考：《山东医药》2017年21期

【摘要】：目的评价超声引导下收肌管阻滞(ACB)在全膝关节置换术后多模式联合镇痛中的作用。方法选择择期行初次单侧膝关节置换术的患者60例,随机分为A、B组各30例。术中均采用喉罩全凭静脉全麻,A组在麻醉诱导前行超声引导下ACB,阻滞成功后注射0.5%罗哌卡因20 m L;B组不行神经阻滞。记录术后静态和动态视觉模拟评分法(VAS)、术后48 h内镇痛泵有效按压次数、吗啡补救镇痛用量及手术前后患肢股四头肌肌力Lovett评分、运动阻滞改良Bromage评分;记录术后24、48、72 h、出院时患肢膝关节最大主动活动,术后第1次下床活动时间和第1次主动直腿抬高时间;统计镇痛相关不良反应发生率。结果 A组术后静态和动态VAS、术后48 h内镇痛泵按压次数,吗啡补救镇痛用量,术后24、48、72 h、出院时膝关节最大主动活动度,术后第1次下床活动时间和第1次主动直腿抬高时间,恶心呕吐、皮肤瘙痒、头晕发生率与B组比较,P均0.05。结论在全膝关节置换采用ACB为主的多模式联合镇痛方案,术后镇痛效果佳,运动阻滞轻微,不良反应发生率低。
[Abstract]:Objective to evaluate the effect of ultrasound-guided adductor catheter block (ACBs) on multi-mode combined analgesia after total knee arthroplasty. Methods 60 patients with primary unilateral knee arthroplasty were randomly divided into group A (n = 30) and group B (n = 30). All patients were treated with laryngeal mask total intravenous general anesthesia group A under ultrasonic guidance before anesthesia induction. After successful anesthesia, 0.5% ropivacaine was injected into group B and no nerve block was achieved. Visual analogue scores of static and dynamic postoperatively were recorded. The effective times of analgesia pump, the amount of morphine analgesia, the Lovett score of quadriceps femoris muscle strength before and after operation and the modified Bromage score of motor block were recorded within 48 hours after operation. The maximal active movement of knee joint was recorded at 24 minutes and 48 minutes 72 hours after discharge, the first time of getting out of bed and the first time of active straight leg elevation were recorded, and the incidence of adverse reactions related to analgesia was counted. Results in group A, the postoperative static and dynamic VASs, the number of analgesic pump compressions within 48 hours after operation, the amount of morphine relief analgesia, the maximum active movement of the knee joint at the time of discharge, the first time of getting out of bed and the first time of active straight leg raising were observed in group A. The incidence of nausea and vomiting, pruritus and dizziness in group B were 0.05. Conclusion in total knee arthroplasty, combined analgesia with ACB is effective, motor block is mild and adverse reaction rate is low.
【作者单位】：济宁市第一人民医院;
【基金】：济宁市科技发展计划医药卫生项目(2015-57-07)
【分类号】：R614

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