摘要
目的探讨不同浓度罗哌卡因应用于腰丛坐骨神经联合阻滞对全膝关节置换术(TKA)患者术后镇痛及肌力恢复的影响。方法回顾性分析2017年3月-2018年12月行腰丛坐骨神经联合阻滞干预的TKA患者138例,按罗哌卡因的浓度分为高、中、低浓度组,每组46例。高、中、低浓度组罗哌卡因浓度分别为0.375%、0.25%、0.15%。比较3组术后2 h及术后24 h疼痛程度、应激反应、炎症反应和术后2 h及术后72 h股四头肌肌张力,并记录3组不良反应发生情况。结果3组术后2 h视觉模拟评分法(VAS)评分、血清血管紧张素Ⅱ(Ang-Ⅱ)、皮质醇(Cor)、白介素-6(IL-6)、IL-10水平比较差异无统计学意义(P>0.05);术后24 h时,3组VAS评分较术后2 h降低,血清Ang-Ⅱ、Cor、IL-6均较术后2 h升高,且高、中浓度组低于低浓度组,高浓度组低于中浓度组(P<0.05);3组术后24 h血清IL-10水平均较术后2 h降低,且高、中浓度组高于低浓度组,高浓度组高于中浓度组(P<0.05)。3组术后2 h、72 h组间股四头肌Ashworth量表(MAS)评分比较差异无统计学意义(P>0.05),但术后72 h时,3组股四头肌MAS评分均较术后2 h升高(P<0.05)。3组不良反应发生率比较差异无统计学意义(P>0.05)。结论0.15%、0.25%及0.375%罗哌卡因应用于腰丛坐骨神经联合阻滞对TKA患者均能发挥良好镇痛作用,且不良反应均较少,但0.375%罗哌卡因镇痛效果更好,抑制炎症及应激反应作用更强,于患者术后康复更有利。
Objective To explore the effects of different concentrations of ropivacaine applied in combined lumbar plexus-sciatic nerve block on postoperative analgesia and muscle strength recovery in patients undergoing total knee arthroplasty(TKA).Methods A retrospective analysis of 138 TKA patients with combined lumbar plexus-sciatic nerve block intervention from March 2017 to December 2018 was divided into high,medium and low concentration groups according to the concentration of Ropivacaine(n=46 in each group).The concentrations of Ropivacaine in the high,medium and low concentration groups were 0.375%,0.25%and 0.15%,respectively.The pain level,stress response,inflammatory response and quadriceps femoris muscle tension at 2 h and 72 h after operation were compared among the three groups,and the occurrence of adverse reactions was recorded in the three groups.Results There was no statistically significant difference in the level of visual analogue scale(VAS)score,serum angiotensinⅡ(Ang-Ⅱ),cortisol(Cor),interleukin-6(IL-6)and IL-10 in the three groups at 2 h after operation(P>0.05);At 24 h after operation,the VAS scores of the three groups were lower while serum Ang-Ⅱ,Cor,and IL-6 were all higher,as compared with those at 2 h after operation,and the scores in high and medium concentration groups were lower than those in the low concentration groups,which were lower in high concentration group than in medium concentration group(P<0.05).The level of serum IL-10 at 24 h after operation in the three groups was lower than that at 2 h after operation,and the level in the high and medium concentration groups was higher than that in the low concentration group,which was higher in the high concentration group than in the medium concentration group(P<0.05).There was no significant difference in the Ashworth Scale(MAS)scores of the quadriceps between the three groups at 2 h and 72 h after operation(P>0.05).However,at 72 h after operation,the MAS scores of the quadriceps of the three groups were higher than those at 2 h after o
作者
师雄
段炜
SHI Xiong;DUAN Wei(Department of Anesthesiology,Chongqing Orthopaedic Hospital of Traditional Chinese Medicine,Chongqing 400012,China;Department of Neurology,the Second Affiliated Hospital of Army Medical University,Chongqing 400000,China)
出处
《解放军医药杂志》
CAS
2020年第7期100-104,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
重庆市社会民生科技创新项目资助(cstc2015shmszx120106)。
