摘要
目的 探讨床旁超声引导下连续隐神经阻滞联合全身麻醉在老年膝关节置换术中的应用效果及其对定向力、股四头肌肌力的影响.方法 回顾性选取2020年11月至2023年11月在延安市人民医院行膝关节置换术的102例老年患者,按照麻醉方法不同分为观察组与对照组,每组各51例.所有患者术中均采取0.3 μg/kg舒芬太尼,0.03 mg/kg咪达唑仑,0.3 mg/kg依托咪酯与0.2 mg/kg顺式阿曲库铵进行全身麻醉,对照组术后进行超声引导下连续股神经阻滞,观察组术后进行超声引导下连续隐神经阻滞,麻醉药物均为20 mL 0.2％罗哌卡因,持续阻滞48 h.比较两组患者术后1、4、8、12、24、48 h静息与活动时疼痛数字评分法(NRS)评分,术后3、5及7 d采用Berg平衡量表(BBS)评价其定向力,比较其术后4、6、8、12、24、48 h股四头肌肌力变化,比较两组患者术后1、7 d血清应激反应指标水平,并比较两组患者下床时间及远期膝关节功能.结果 两组患者术后1、4、8、12、24、48 h活动时NRS评分与静息时NRS评分比较,差异均无统计学意义(P＞0.05).观察组术后3、5、7 d的BBS评分分别为(37.96±5.21)、(43.06±5.13)、(49.27±3.34)分,均明显高于对照组[(31.91±6.32)、(38.57±4.15)、(41.36±4.44)分],差异均有统计学意义(P＜0.05).术后4 h,两组患者股四头肌肌力比较,差异无统计学意义(P＞0.05);观察组术后6、8、12、24、48 h股四头肌肌力分别为(1.95±0.13)、(2.42±0.15)、(2.75±0.41)、(3.11±0.33)、(3.93±0.42)分,均高于对照组[(1.56±0.20)、(2.01±0.13)、(2.14±0.23)、(2.76±0.42)、(3.11±0.35)分],差异均有统计学意义(P＜0.05).术后 1 d,两组患者皮质醇、去甲肾上腺素、肾上腺素水平比较,差异均无统计学意义(P＞0.05);术后7 d,两组患者皮质醇、去甲肾上腺素、肾上腺素水平均较术后1 d降低,差异均有统计学意义(P＜0.05),但两组患者术后7 d皮质醇、去甲肾上腺素、肾上腺素水平比较,差异均无统计学意义(P＞0.05).观察组患者首次下床时间为(1.41±0.34)d,明显短于对照组[(2.12±0.35)d],差异有统计学意义(P＜0.05).观察组术后3、6个月的HSS评分分别为(76.11±7.24)、(87.67±12.36)分,均明显高于对照组[(71.11±6.23)、(82.37±11.52)分],差异均有统计学意义(P＜0.05).结论 老年膝关节置换术中应用床旁超声引导下连续隐神经阻滞联合全身麻醉效果显著,可降低患者术后疼痛程度,减轻患者应激反应,但与连续股神经阻滞比较可进一步改善患者定向力及股四头肌肌力,缩短术后卧床时间,辅助改善患者术后远期膝关节功能水平.
Abstract
Objective To explore the application effect of continuous saphenous nerve block combined with general anesthesia under bed-side ultrasound guidance on elderly knee replacement surgery and the influence of directional force and quadriceps muscle strength.Methods A total of 102 elderly patients who underwent knee joint replacement surgery at Yan'an People's Hospital from November 2020 to November 2023 were retrospectively selected and divided into the observation group and the control group according to the different anesthesia methods,with 51 cases in each group.All patients underwent general anesthesia with 0.3 μg/kg sufentanil,0.03 mg/kg midazolam,0.3 mg/kg etomidate,and 0.2 mg/kg cisatracurium during surgery.The control group underwent ultrasound-guided continuous femoral nerve block after surgery,while the observation group underwent ultrasound-guided continuous saphenous nerve block after surgery.The anesthetic was 20 mL 0.2％ropivacaine for 48 hours.The resting and active pain numerical scale(NRS)scores of two groups of patients at 1 hour,4 hours,8 hours,12 hours,24 hours,and 48 hours after surgery were compared.The directional force of two groups of patients at 3 days,5 days,and 7 days after surgery was evaluated using the Berg balance scale(BBS).The changes in quadriceps muscle strength at 4 hours,6 hours,8 hours,12 hours,24 hours,and 48 hours after sur-gery of two groups of patients were compared.The levels of serum stress response indicators at 1 day,and 7 days after surgery,and finally first time of got out of bed and long-term knee joint function of two groups of patients were compared.Results There were no statistically significant differ-ences in NRS score during activity and NRS score at rest between the two groups of patients at 1 hour,4 hours,8 hours,12 hours,24 hours,and 48 hours after surgery(P＞0.05);The BBS scores of the observation group at 3,5,and 7 days after surgery were(37.96±5.21),(43.06±5.13),and(49.27±3.34)points,respectively,which were significantly higher than those of the control group[31.91±6.32),(38.57±4.15),and(41.36±4.44)points],and the differences were statistically significant(P＜0.05).There was no statistically significant differ-ence in the strength of the quadriceps femoris muscle between the two groups of patients at 4 hours after surgery(P＞0.05).The strength of the quadriceps femoris muscle in the observation group at 6,8,12,24,and 48 hours after surgery were(1.95±0.13),(2.42±0.15),(2.75±0.41),(3.11±0.33),and(3.93±0.42)points,respectively,which were higher than those of the control group[(1.56±0.20),(2.01±0.13),(2.14±0.23),(2.76±0.42),(3.11±0.35)points],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in cortisol,norepinephrine,and adrenaline levels between the two groups of patients at 1 day after surgery(P＞0.05);the levels of cortisol,norepinephrine,and adrenaline in the two groups of patients at 7 days after surgery were lower than those at 1 day af-ter surgery,and the differences were statistically significant(P＜0.05).However,there were no statistically significant differences in the levels of cortisol,norepinephrine,and adrenaline between the two groups at 7 days after surgery(P＞0.05).The first time of got out of bed in the ob-servation group was(1.41±0.34)days,which was significantly shorter than that in the control group[(2.12±0.35)days],and the difference was statistically significant(P＜0.05).The HSS scores of the observation group at 3 and 6 months after surgery were(76.11±7.24)and(87.67±12.36)points,respectively,which were significantly higher than those of the control group[(71.11±6.23)and(82.37±11.52)points],and the differences were statistically significant(P＜0.05).Conclusion Elderly knee replacement application bedside ultrasound guided continuous cryptic nerve block combined with general anesthesia effect is remarkable,can reduce the postoperative pain,reduce patients with stress response,but compared with continuous femoral nerve block can further improve the directional force and femoral quadriceps strength,shorten the postoperative bed time,auxiliary improve postoperative future knee function level.
基金项目
陕西省科协企业创新争先青年人才托举计划(2021-1-2)
维普
万方数据