超声导航连续隐神经阻滞对膝关节置术后康复影响的研究

发布时间：2019-06-27 16:20

【摘要】：目的:比较超声导航下缝匠肌下入路连续隐神经阻滞与腹股沟入路连续股神经阻滞分别应用于人工全膝关节置换术(total knee arthroplasty,TKA)术后镇痛对术后康复质量的影响。方法:根据试验所定入选标准以及排除标准选择择期在我院腰麻下行人工单侧全膝关节置换术患者50例,随机将患者分为观察组连续缝匠肌下入路隐神经阻滞镇痛S组和对照组连续腹股沟入路股神经阻滞镇痛F组,每组25例。患者常规入室后建立外周静脉,以8-10ml/kg外周静脉输注钠钾镁葡萄糖注射液(乐加),随后以5-10ml/kg/h的速度维持输液,术中根据出血量以及手术时间控制输液总量。S组患者行单次腰麻平面固定后在超声导航下缝匠肌下入路收肌管隐神经旁留置导管,F组患者行单次腰麻平面固定后在超声导航下腹股沟入路股神经旁留置导管。两组患者腰麻皆选择L3-4间隙穿刺,注射局麻药物时针尖斜面朝向尾侧,注药速度1ml/5s,局麻药物选择1%盐酸罗哌卡因2ml+0.9%NS1ml混合液共3ml。两组患者均在腰麻完成后用酒精擦拭法确定麻醉效果,将麻醉平面控制在T8以下。手术结束前20分钟两组患者皆通过留置导管在外周神经旁推注0.25%罗哌卡因15ml负荷量,然后连接一次性便携式输注系统。输注泵内药物成份为1%盐酸罗哌卡因40ml+地阿塞米松5mg+0.9%生理盐水120ml,总量为160ml,为48小时用量,48小时后按同样比例重新配置局麻镇痛药一次(模式输注泵背景剂量3ml/h,患者自控量4ml/h,锁定间隔时间为15分钟)。术后康复过程中通过观察并记录两组患者不同观察点的阿片类药物使用总量、睡眠中断次数、静息以及运动疼痛评分、股四头肌肌力、膝关节活动度、步行距离、血浆IL-6、C反应蛋白以及术后血糖水平来评价康复质量。结果:我们对参与并完成实验的50例患者进行了统计学分析。两组患者在年龄、体重、性别、手术时间、术前股四头肌肌力、术前血浆CRP、IL-6,住院时间上的差异无统计学意义(P0.05)。S组患者在术后24h阿片类镇痛药物使用量、48h内睡眠中断次数、术后各观察点静息VAS与F组比较,也无显著性差异(P0.05)。术后4-72h各观察点股四头肌肌力、被动与主动关节活动度以及CPM肌训练时VAS评分、步行距离,患者术后血浆应激反应指标(IL-6,GLU,CRP)等两组比较,S组明显优于F组(P0.05)。结论:对于人工膝关节置换(TKA)患者来说,超声引导缝匠肌下入路连续隐神经阻滞能够更确切地提高术后康复质量。与目前常用的持续股神经阻滞相比,镇痛效果相当,股四头肌肌力影响小,应激反应更轻,术后康复锻炼舒适度更高。
[Abstract]:Objective: to compare the effects of continuous occlusal nerve block via subsartorius muscle approach under ultrasound navigation and continuous thigh nerve block via inguinal approach on postoperative rehabilitation quality of total knee arthroplasty (total knee arthroplasty,TKA). Methods: according to the selection criteria and exclusion criteria, 50 patients undergoing artificial unilateral total knee arthroplasty under lumbar anesthesia in our hospital were randomly divided into observation group (n = 25) and control group (n = 25). After routine entry, the peripheral veins were established and sodium, potassium, magnesium, glucose injection (Lega) was infused intravenously with 8-10ml/kg, and then the infusion was maintained at the speed of 5-10ml/kg/h. The total amount of infusion was controlled according to the amount of bleeding and the operation time. The patients in group S were treated with single lumbar anesthesia plane fixation and indwelling catheter of adductor tunnel by ultrasonic navigation inferior sartorius muscle approach. In group F, patients were treated with single lumbar anesthesia plane fixation and indwelling catheter by inguinal approach under ultrasound navigation. L3 鈮，

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