超声引导下持续股神经阻滞在全膝关节置换术后镇痛的效果观察

发布时间：2018-08-30 14:24

【摘要】：目的观察超声引导下持续股神经阻滞在全膝关节置换术后镇痛的效果与不良反应,与传统静脉自控镇痛进行对照研究。方法选择2015年8月至2016年3月该院择期行单侧膝关节置换术患者40例,分为A、B两组,每组20例。A组采用超声引导下持续股神经阻滞镇痛,B组采用静脉自控镇痛。比较两组术后4、8、12、24、48h静息视觉模拟评分(VAS),术后24、48、72h持续被动运动时的VAS评分,术后2、3、4、5、6d肌力分级及膝关节最大被动屈伸活动度,术后不良反应发生情况,两组血清C-反应蛋白(CRP)及白细胞介素-6(IL-6)的水平,下肢超声监测深静脉血栓发生情况及血清D-二聚体水平的变化。结果 A组患者术后各时间点静息状态VAS评分明显低于B组(P0.05),A组术后24、48、72h持续被动功能锻炼时的VAS评分明显低于B组(P0.05)。A组患者术后第2、3、4天被动屈伸活动度明显高于B组(P0.05),两组患者术后各时间点患肢肌力无明显差异(P0.05)。A组患者术后自控镇痛按压次数少于B组(P0.05)。两组患者加用镇痛药情况无明显差异(P0.05)。A组术后6、24hCRP水平低于B组(P0.05)。两组患者术后IL-6水平均高于术前(P0.05),但组间无明显差异(P0.05)。两组患者超声结果显示下肢深静脉血栓形成情况比较差异无统计学意义(P0.05)。A组患者围术期D-二聚体水平低于B组(P0.05)。结论超声引导下持续股神经阻滞应用于膝关节置换手术患者的术后镇痛,镇痛效果确切,能减轻术后应激损伤,降低术后并发症的发生率,有利于巩固手术治疗效果。
[Abstract]:Objective to observe the analgesic effect and side effects of continuous femoral nerve block under ultrasound guidance after total knee arthroplasty, and to compare it with traditional patient-controlled intravenous analgesia. Methods from August 2015 to March 2016, 40 patients undergoing unilateral knee arthroplasty were divided into two groups: group A (n = 20) received continuous femoral nerve block analgesia under ultrasound guidance and group B (n = 20) received patient-controlled intravenous analgesia. The visual analogue score of 48 hours after (VAS), was compared between the two groups. The VAS score of passive motion for 24 minutes and 72 hours after (VAS), the muscle strength grading and the maximum passive flexion and extension of the knee joint at 2: 3, 4, 5 and 5 days after operation, and the incidence of postoperative adverse reactions were compared between the two groups. The levels of serum C-reactive protein (CRP) and interleukin-6 (IL-6), and the changes of serum D-dimer and the occurrence of deep venous thrombosis (DVT) were monitored by ultrasound in the two groups. Results the VAS score of resting state in group A was significantly lower than that in group B (P0.05). The VAS score of group A was significantly lower than that of group B (P0.05) after 24 minutes and 72 hours of continuous passive exercise (P0.05). The activity of passive flexion and extension in group A was significantly higher than that in group A on the 2nd day and 3rd day after operation. Group B (P0.05), there was no significant difference in muscle strength of affected limbs between the two groups at each time point (P0.05). The number of postoperative patient-controlled analgesia in group A was less than that in group B (P0.05). There was no significant difference between the two groups in addition of analgesics (P0.05). The level of CRP in group A was lower than that in group B (P0.05). The level of IL-6 in the two groups was higher than that before operation (P0.05), but there was no significant difference between the two groups (P0.05). The results of ultrasound showed that there was no significant difference between the two groups (P0.05). The level of Ddimer in group A was lower than that in group B (P0.05). Conclusion Ultrasound-guided continuous femoral nerve block is effective for postoperative analgesia in patients undergoing knee arthroplasty. It can reduce postoperative stress injury, reduce the incidence of postoperative complications and consolidate the effect of surgical treatment.
【作者单位】：石河子大学医学院第一附属医院麻醉科;
【基金】：石河子大学医学院第一附属医院院级基金资助项目(YL2015S018)
【分类号】：R614

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