摘要
目的探讨超声引导下收肌管联合膝关节囊后间隙阻滞对老年全膝关节置换术(TKA)后镇痛及炎症反应的影响。方法选取2017-06—2019-12在郑州市第三人民医院择期行TKA治疗的老年患者98例,随机分为收肌管组(48例)和联合组(50例)。2组患者均接受脊椎-硬膜外联合麻醉下TKA。麻醉前,收肌管组患者采取超声引导下收肌管阻滞,联合组患者则采取超声引导下收肌管联合膝关节囊后间隙阻滞。2组患者术后均行自控静脉镇痛(PCIA)。分别于术后6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))和72 h(T_(5))时,评估患者静息时和活动时VAS评分,记录2组患者第一次补救镇痛时间、补救镇痛次数、48 h舒芬太尼使用量,以及首次下床活动时间。分别于T_(2)、T_(3)、T_(4)和T_(5)时,测定股四头肌肌力和膝关节活动度。分别于术前(T_(0))、T_(1)、T_(3)、T_(4)和T_(5)时,使用放射免疫法检测血清中IL-6和IL-10水平。结果2组患者一般资料差异无统计学意义(P>0.05)。联合组T_(1)~T_(3)时静息和活动时的VAS评分均低于收肌管组,第一次补救镇痛时间长于收肌管组,而补救镇痛次数、48 h舒芬太尼使用量和首次下床活动时间均少(短)于收肌管组,差异有统计学意义(P<0.05)。联合组患者T_(2)~T_(4)时膝关节活动度高于收肌管组,T_(1)~T_(4)时血清IL-6和IL-10水平低于收肌管组,差异有统计学意义(P<0.05)。结论超声引导下收肌管联合膝关节囊后间隙阻滞应用于老年TKA,术后镇痛效果良好,可减少阿片类药物使用量,促进早期膝关节功能恢复,降低机体炎症反应水平。
Objective To investigate the effect of ultrasound-guided adductor canal block combined with posterior capsular space of knee joint on analgesia and inflammation after total knee arthroplasty(TKA)in the elderly patients.Methods A total of 98 cases of elderly patients who underwent TKA treatment in our hospital were selected from June 2017 to December 2019.All patients were randomly divided into adductor tube group(48)and combined group(50).All patients in the two groups were received TKA under combined spinal-epidural anesthesia.Before anesthesia,the patients in the adductor tube group received ultrasound-guided adductor canal block,and patients in the combined group received ultrasound-guided adductor canal block combined with posterior capsular space of knee joint.All patients in both groups received PCIA after operation.Respectively,at 6 h(T_(1)),12 h(T_(2)),24 h(T_(3)),48 h(T_(4))and 72 h(T_(5))after surgery,the patient's VAS scores at resting and exercising were evaluated.The time of the first rescue analgesic,the number of rescue analgesic,the amount of sufentanil usage within 48 hours and the time of first getting out of bed of patients were recorded in the two groups.Respectively,at T_(2),T_(3),T_(4) and T_(5),the quadriceps strength levels and the range of motion of the knee joint were measured.Respectively,at before surgery(T_(0)),T_(2),T_(3),T_(4) and T_(5),the serum levels of IL-6 and IL-10 were detected by radioimmunoassay.Results The VAS scores at resting and exercising at T_(1)~T_(3) in the combined group were lower than those of the adductor tube group,and the differences were statistically significant(P<0.05).The time of the first rescue analgesic of patients in the combined group was longer than that in the adductor tube group,while the number of rescue analgesic,the amount of sufentanil usage within 48 hours and the time of first getting out of bed of patients were less than those of the adductor tube group,and the differences were statistically significant(P<0.05).The range of motion of the kne
作者
陈俊峰
李艳
赵宁
刘慧玲
邵新学
Chen Junfeng;Li Yan;Zhao Ning;Liu Huiling;Shao Xinxue(Department of Pain,The Third People Hospital of Zhengzhou,Zhengzhou 450000,China)
出处
《河南外科学杂志》
2021年第5期23-27,共5页
Henan Journal of Surgery
关键词
关节成形术
置换
膝
超声引导
神经阻滞
镇痛
炎症反应
Arthroplasty
Replacement
Knee
Ultrasound guide
Nerve block
Analgesia
Inflammatory response