摘要
目的探讨股内侧肌下入路隐神经阻滞在高龄全膝关节置换术中的效果。方法选取2020年1月至2022年1月浙江省丽水市人民医院收治的104例高龄全膝关节置换术患者,依照随机数字表法将其分为研究组(52例)和对照组(52例)。对照组采用大转子下外侧入路坐骨神经阻滞麻醉,研究组采用股内侧肌下入路隐神经阻滞麻醉。比较两组手术指标和神经阻滞指标;比较两组术前(T_(0))、术后6 h(T_(1))、术后12 h(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))静息和活动状态视觉模拟评分法(VAS)评分;比较两组术后1、6个月膝关节功能评分;观察不良反应发生情况。结果两组手术时间、麻醉操作完成时间、感觉阻滞起效时间、感觉阻滞维持时间、运动阻滞起效时间、运动阻滞维持时间、运动阻滞效果评分比较,差异无统计学意义(P>0.05);研究组感觉阻滞效果评分高于对照组,差异有统计学意义(P<0.05)。T_(1)时,两组静息和活动状态VAS评分与T_(0)时比较,差异无统计学意义(P>0.05);T_(2)~T_(4)时,两组静息和活动状态VAS评分高于T_(0)时,差异有统计学意义(P<0.05)。T_(0)~T_(1)时,两组静息和活动状态VAS评分比较,差异无统计学意义(P>0.05);T_(2)~T_(4)时,研究组静息和活动状态VAS评分低于对照组,差异有统计学意义(P<0.05)。术后6个月,两组膝关节功能评分高于术后1个月,差异有统计学意义(P<0.05);术后1、6个月,两组膝关节功能评分比较,差异无统计学意义(P>0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论股内侧肌下入路隐神经阻滞用于高龄全膝关节置换术患者可以增强镇痛效果,减轻术后疼痛,安全可靠。
Objective To explore the effect of saphenous nerve block through inferior approach of medial femoris muscle in total knee arthroplasty in advanced age.Methods A total of 104 advanced age patients with total knee arthroplasty admitted to Lishui People’s Hospital,Zhejiang Province from January 2020 to January 2022 were selected,they were divided into study group(52 cases)and control group(52 cases)according to the random number table method.The control group received sciatic nerve block anesthesia through lower outer approach of large rotor,and study group was anesthetized by saphenous nerve block through inferior approach of medial femoris muscle.Surgical indexes and nerve block indexes were compared between two groups;visual analogue scale(VAS)scores of resting and active state were compared between two groups before surgery(T_(0)),6 h after surgery(T_(1)),12 h after surgery(T_(2)),24 h after surgery(T_(3))and 48 h after surgery(T_(4));the knee function scores of two groups were compared one and six months after surgery;the occurrence of adverse reactions was observed.Results There were no significant differences in operation time,anesthesia completion time,sensory block onset time,sensory block maintenance time,motor block onset time,motor block maintenance time,and motor block effect score between two groups(P>0.05);the sensory block effect score in study group was higher than that in control group,and the difference was statistically significant(P<0.05).At T_(1),there were no significant differences in resting and active VAS scores between two groups compared with T_(0)(P>0.05);at T_(2)-T_(4),the resting and active VAS scores of two groups were higher than those at T_(0),and the differences were statistically significant(P<0.05).At T_(0)-T_(1),there was no significant differences in resting and active VAS scores between two groups(P>0.05);At T_(2)-T_(4),the resting and active VAS scores of study group were lower than those of control group,and the differences were statistically significant(P<0.05).Six months after surgery,the knee function scores of two groups were higher than those of one month after surgery,and the differences were statistically significant(P<0.05);one and six months after surgery,there was no significant difference in knee function scores between two groups(P>0.05).There was no significant difference in the total incidence of adverse reactions between two groups(P>0.05).Conclusion It is safe and reliable to apply saphenous nerve block through inferior approach of medial femoris muscle in total knee arthroplasty in advanced age,which can enhance analgesic effect and reduce postoperative pain.
作者
梅培毅
吴继敏
武旖旎
叶绿菊
MEI Peiyi;WU Jimin;WU Yini;YE Lvju(Department of Anesthesiology,Lishui People’s Hospital,Zhejiang Province,Lishui 323000,China;Department of Obstetrics and Gynecology,Lishui Maternal and Child Health Hospital,Zhejiang Province,Lishui 323000,China)
出处
《中国医药导报》
CAS
2023年第16期117-121,共5页
China Medical Herald
基金
浙江省医药卫生科技计划项目(2020KY345)。
关键词
大转子下外侧入路
坐骨神经阻滞
股内侧肌下入路
隐神经阻滞
高龄
全膝关节置换术
Lower outer approach of large rotor
Sciatic nerve block
Inferior approach of medial femoris muscle
Saphenous nerve block
Advanced age
Total knee arthroplasty
