摘要
目的探讨超声引导下连续股神经阻滞对全膝置换术(TKA)后镇痛及深静脉血栓(DVT)形成的影响。方法收集2018年8月至2021年8月衡水市第二人民医院收治的96例行全膝关节置换术患者的临床资料,根据麻醉方法的不同将患者分为观察组(n=50,采取超声引导下连续股神经阻滞)和对照组(n=46,采取静脉自控镇痛)。比较两组患者的麻醉效果、镇痛情况[视觉模拟评分法(VAS)评分]。比较两组患者术后DVT发生情况、凝血功能指标[(凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血小板计数、纤维蛋白原(FIB)水平)]及不良反应发生情况。结果观察组患者的麻醉操作时间、感觉神经阻滞起效时间均短于对照组患者,感觉神经阻滞持续和感觉神经阻滞完善时间均长于对照组患者,差异均有统计学意义(P﹤0.05)。术后6、24、48 h,观察组患者静息状态和运动状态下的VAS评分均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。观察组患者术后DVT的总发生率明显低于对照组患者,差异有统计学意义(P﹤0.01)。观察组58~60岁、61~70岁患者术后DVT的发生率均低于对照组,差异均有统计学意义(P﹤0.05);两组71~75岁患者的术后DVT发生率比较,差异无统计学意义(P﹥0.05)。观察组患者的术后TT、APTT均明显长于对照组患者,血小板计数、FIB水平、不良反应总发生率均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。结论超声引导下连续股神经阻滞对TKA术后患者的镇痛效果优于静脉自控镇痛,不仅可以改善患者静息、运动状态下的疼痛程度,还可改善患者的凝血功能,检索术后DVT及不良反应的发生。
Objective To investigate the effect of ultrasound guided continuous femoral nerve block on analgesia and deep vein thrombosis(DVT)after total knee arthroplasty(TKA).Method Clinical data of 96 patients undergoing TKA in the Second People's Hospital of Hengshui from August 2018 to August 2021 were collected.According to different anesthesia methods,96 patients undergoing TKA were divided into the observation group(n=50,received ultrasound guided continuous femoral nerve block)and control group(n=46,received intravenous patient-controlled analgesia).The anesthesia effect,analgesic status[visual analogue scale(VAS)scores],occurrence of postoperative DVT,coagulation function indicators[thrombin time(TT),activated partial thromboplastin time(APTT),platelet count,fibrinogen(FIB)level],and adverse reactions between the two groups were compared.Result The operation time of anesthesia and the onset time of sensory nerve block in the observation group were shorter than those in the control group,the duration and perfection time of sensory nerve block in the observation group were longer than those in the control group,and the differences were statistically significant(P<0.05).At 6,24,and 48 hours after surgery,the VAS scores of the observation group during rest and exercise were significantly lower than those in the control group,and the differences were statistically significant(P<0.01).The total incidence rate of postoperative DVT in the observation group was significantly lower than that in the control group,and the differences were statistically significant(P<0.01).The incidence rate of postoperative DVT in patients aged 58-60 and 61-70 in the observation group was lower than that in the control group(P<0.05);there was no statistically significant difference in the incidence rate of postoperative DVT between two groups of patients aged 71-75(P>0.05).The TT and APTT of the observation group were significantly longer than those of the control group,the platelet count,FIB level and total incidence rate of postoperative adv
作者
戎瑞爽
种丽双
宋琳琳
邓瑞晨
Rong Ruishuang;Zhong Lishuang;Song Linlin;Deng Ruichen(Department of Anesthesiology,the Second People's Hospital of Hengshui,Hengshui 053000,Hebei,China;Department of General Surgery,the Second People's Hospital of Hengshui,Hengshui 053000,Hebei,China)
出处
《血管与腔内血管外科杂志》
2023年第6期735-739,共5页
Journal of Vascular and Endovascular Surgery
关键词
超声引导
连续股神经阻滞
全膝置换术
术后镇痛
深静脉血栓
ultrasound guidance
continuous femoral nerve block
total knee arthroplasty
postoperative analgesia
deep vein thrombosis
