摘要
目的比较超声引导股神经阻滞与髂筋膜腔隙阻滞在全膝关节置换术后镇痛的效果。方法选择2016年6月至2018年6月永康市骨科医院接诊的全膝关节置换术患者96例为研究对象,采用随机数字表法将患者分为两组各48例。对照组使用超声引导股神经阻滞,观察组采用超声引导髂筋膜腔隙阻滞。比较两组患者术后4 h、8 h、12 h、24 h及48 h的静息和运动时视觉模拟疼痛(VAS)评分、穿刺注药时间、芬太尼累计用量、苏醒时间、有效镇痛时间、患肢主动关节屈曲角及不良反应发生情况。结果两组患者术后各个时点静息状态下VAS评分差异均无统计学意义(均P>0.05);在活动下,观察组术后4 h、8 h、12 h和24 h时VAS评分[(2.16±0.58)分、(2.03±0.52)分、(1.94±0.47)分、(1.86±0.51)分]均低于对照组[(2.55±0.63)分、(2.46±0.61)分、(2.31±0.55)分、(2.17±0.58)分],差异均有统计学意义(t=3.156、3.717、3.543、2.871,均P<0.05);观察组穿刺注药时间[(2.61±0.41)min]短于对照组[(4.20±0.61)min],差异有统计学意义(t=14.988,P<0.05);观察组芬太尼累计用量[(0.51±0.02)mg]少于对照组[(0.68±0.04)mg],差异有统计学意义(t=26.336,P<0.05);两组患者麻醉苏醒时间差异无统计学意义;观察组有效镇痛时间、术后24 h、48 h患肢主动关节屈曲角[(39.17±3.52)h、(47.99±4.78)°、(68.97±4.13)°]明显高于对照组[(27.34±1.23)h、(30.12±4.68)°、(45.52±3.87)°],差异均有统计学意义(t=21.981、18.507、28.705,均P<0.05);手术后,患者均出现恶心呕吐、瘙痒、穿刺点血肿等并发症,观察组总发生率为4.17%(2/48),低于对照组的16.67%(6/48),差异有统计学意义(χ2=4.019,P<0.05)。结论超声引导髂筋膜腔隙阻滞镇痛在全膝关节置换术患者中的应用效果显著优于股神经阻滞,可有效降低疼痛及不良反应发生情况。
Objective To compare the analgesic effect of ultrasound-guided femoral nerve block and iliofascial lacuna block after total knee arthroplasty.Methods From June 2016 to June 2018,96 patients with total knee replacement in Orthopaedic Hospital of Yongkang were selected in this research and divided into two groups by random number table method,with 48 cases in each group.The control group was treated with ultrasound-guided femoral nerve block,and the observation group was treated with ultrasound-guided iliofascial lacuna block.Visual analogue(VAS)pain score,puncture injection time,cumulative fentanyl dosage,recovery time,effective analgesia time,active joint flexion angle and adverse reactions of the affected limb were compared between the two groups at 4 h,8 h,12 h,24 h and 48 h after surgery.Results There were no statistically significant differences in VAS score at each postoperative time point between the two groups(all P>0.05).At 4 h,8 h,12 h and 24 h after surgery,the VAS scores in the observation group[(2.16±0.58)points,(2.03±0.52)points,(1.94±0.47)points,(1.86±0.51)points]were significantly lower than those in the control group[(2.55±0.63)points,(2.46±0.61)points,(2.31±0.55)points,(2.17±0.58)points](all P<0.05).The time of puncture injection and the cumulative dose of fentanyl were compared between the two groups.The time of puncture injection in the observation group[(2.61±0.41)min]was shorter than that in the control group[(4.20±0.61)min],and the difference was statistically significant(P<0.05).The cumulative dosage of fentanyl in the observation group[(0.51±0.02)mg]was less than that in the control group[(0.68±0.04)mg],and the difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in anesthesia recovery time between the two groups(P>0.05).The effective analgesic time,limb active joint flexion angle at 24 h,48 h after operation in the observation group[(39.17±3.52)h,(47.99±4.78)°,(68.97±4.13)°]were significantly higher than those in the control group[(27.34±1.23)h,(30.12±4.68)°,(45.52±3.87)°],the differences were statistically significant(all P<0.05).After treatment,all patients had complications such as nausea and vomiting,pruritus,and hematoma at the puncture point.The total incidence of the observation group(4.17%)was lower than that of the control group(16.67%),the difference was statistically significant(χ2=4.019,P<0.05).Conclusion Ultrasound-guided iliac fascial space block analgesia is significantly better than femoral nerve block in total knee replacement patients,which can effectively reduce pain and adverse reactions.
作者
陈冬圭
朱奔奔
Chen Donggui;Zhu Benben(Department of Anesthesiology,Orthopaedic Hospital of Yongkang,Yongkang,Zhejiang 321300,China)
出处
《中国基层医药》
CAS
2020年第3期280-283,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
关节成形术
置换
膝
麻醉
超声检查
股神经
筋膜
疼痛
Arthroplasty
replacement
knee
Anesthesia
Ultrasonography
Femoral nerve
Fascia
Pain
