摘要
目的比较接受膝关节置换的老年患者单独采取超声引导下连续收肌管阻滞与联合膝关节局部浸润在术后镇痛效果及谵妄发生方面的不同。方法选取2018年5月至2020年5月在郑州人民医院择期行全麻下全膝关节置换术(total knee arthroplasty,TKA)治疗的患者122例,随机分为阻滞组和联合组,每组61例,两组患者均采用相同的麻醉和手术方法,阻滞组患者于麻醉诱导后,接受超声引导下连续收肌管阻滞,联合组患者在接受超声引导下连续收肌管阻滞的同时,于假体植入后,接受膝关节局部浸润,两组患者术后行自控收肌管阻滞镇痛。分别于术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)和72 h(T5)时,分别于静息和活动时评估患者视觉模拟评分(visual analogue scale,VAS),分别于T1、T2、T3、T4和T5时,评估患者股四头肌肌力和膝关节活动度,记录两组患者术后7 d内术后谵妄(postoperative delirium,POD)发生情况及持续时间、首次下床活动以及术后住院时间,同时比较镇痛补救及发生不良反应情况。结果与阻滞组相比,联合组患者静息时和活动时T1~T5时VAS评分均降低(P<0.05);T1~T5时股阻滞组患者四头肌肌力及膝关节活动度与联合组比较差异无统计学意义(P>0.05);7 d内POD发生率、POD持续时间、首次下床活动时间和术后住院时间联合组患者均低于阻滞组(P<0.05);联合组患者镇痛补救率和不良反应发生率均低于阻滞组(P<0.05)。结论联合膝关节局部浸润较单纯超声引导下连续收肌管阻滞应用于老年TKA镇痛效果更优,可降低POD发生,减少不良反应的发生。
Objective To compared the differences in postoperative analgesic effects and incidence of delirium between elderly patients undergoing knee arthroplasty who received ultrasound-guided continuous adductor canal block alone and those who receivedit combined with local infiltration of the knee joint.Methods A total of 122 cases of patients who underwent total knee arthroplasty(TKA)treatment under general anesthesia were selected in the People's Hospital of Zhengzhou from May 2018 to May 2020.All patients were randomly divided into a continuous adductor canal block group(block group)and an adductor canal block combined with local infiltration anesthesia around knee joint group(combined group),with 61 cases in each group.Patients in the two groups received the same anesthesia and surgical methods.After induction of anesthesia,patients in the block group received ultrasound-guided continuous adductor canal block.Patients in the combined group received ultrasound-guided continuous adductor canal block,and at the same time,received local infiltration anesthesia around knee joint after prosthesis implantation.Patients in the two groups received self−controlled adductor canal block analgesia after surgery.At 6 h(T,),12 h(T2),24 h(T3),48 h(T4)and 72 h(T,)postoperatively,the visual analogue scale(VAS)scores of patients were evaluated at rest and activity.At T,T2,T3,T4 and T5,respectively,the quadriceps muscle strength and range of motion of the knee joint were evaluated.The occurrence and duration of postoperative delirium(POD)within 7 days after the operation of patients in the two groups,as well as the time to first ambulation and the postoperative hospital stay of patients in the two groups were recorded.The remedial analgesia and occurrence of adverse reactions in the two groups were recorded.Results The VAS scores of patients in the combined group at rest and during activity at T,to T5 were lower than those in the block group(P<0.O5).There were no statistically significant differences in quadriceps muscle strength or range of motion of knee joint between the patients in two groups at T,to T5(P>0.05).The incidence of POD within 7 days,the duration of POD,the time to first ambulation and the postoperative hospital stay in the combined group were lower than those in the block group(P<0.05).The requirement for remedial analgesia rate and incidence of adverse reactions after surgery in the combined group were lower than those in the block group(P<0.05).Conclusion Compared with ultrasound guided continuous adductor canal block,combined with local infiltration anesthesia around knee joint applied in the elderly TKA has better analgesic effect,can reduce the occurrence of POD and reduce the occurrence of adverse reactions.
作者
杜增利
翟功伟
屈武功
王兆阳
DU Zeng-li;ZHAI Gong-wei;QU Wu-gong;WANG Zhao-yang(Department of Anesthesiology,the Fifth Clinical Medical College of Henan University of Chinese Medicine,People's Hospital of Zhengzhou,Zhengzhou,Henan 450003,China)
出处
《医药论坛杂志》
2026年第6期606-610,共5页
Journal of Medical Forum
关键词
老年
全膝关节置换术
超声引导下连续收肌管阻滞
膝关节局部浸润
镇痛
谵妄
Elderly
Total knee arthroplasty
Ultrasound guided continuous adductor canal block
Local infiltration anesthesia around knee joint
Analgesia
Delirium
