郭威 王麗麗 王思明

淺析超聲引導(dǎo)下連續(xù)股神經(jīng)阻滯用于全膝關(guān)節(jié)置換術(shù)術(shù)后鎮(zhèn)痛的效果觀察

郭威 王麗麗 王思明

目的探討全膝關(guān)節(jié)置換術(shù)使用超聲引導(dǎo)連續(xù)股神經(jīng)阻滯的鎮(zhèn)痛效果。方法40例單側(cè)全膝關(guān)節(jié)置換術(shù)患者,隨機(jī)分為A、B組,各20例。A組使用超聲引導(dǎo)連續(xù)股神經(jīng)阻滯鎮(zhèn)痛,B組使用靜脈自控鎮(zhèn)痛,全身麻醉進(jìn)行手術(shù)。比較兩組的鎮(zhèn)痛效果。結(jié)果A組2、4、12、24、48 h 視覺(jué)模擬評(píng)分法(VAS)評(píng)分低于B組(P＜0.05)。A組2、4、12 h下肢肌力評(píng)分低于B組(P＜0.05),24、48 h兩組下肢肌力評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。B組患者術(shù)后惡心、嘔吐發(fā)生率40%高于A組10%(P＜0.05)。結(jié)論超聲引導(dǎo)連續(xù)股神經(jīng)阻滯用于全膝關(guān)節(jié)置換術(shù)術(shù)后鎮(zhèn)痛優(yōu)于傳統(tǒng)自控鎮(zhèn)痛,術(shù)后不良反應(yīng)率低,值得臨床推廣使用。

全膝關(guān)節(jié)置換術(shù)；超聲引導(dǎo)；連續(xù)股神經(jīng)阻滯；術(shù)后鎮(zhèn)痛

麻醉領(lǐng)域使用超聲技術(shù)越來(lái)越成熟,超聲引導(dǎo)神經(jīng)阻滯技術(shù)是主要應(yīng)用內(nèi)容［1］。膝關(guān)節(jié)置換術(shù)術(shù)后患者疼痛感強(qiáng)烈,會(huì)導(dǎo)致合并癥出現(xiàn)［2-4］。此次本院就超聲引導(dǎo)連續(xù)股神經(jīng)阻滯在全膝關(guān)節(jié)置換術(shù)術(shù)后鎮(zhèn)痛的使用效果進(jìn)行分析,現(xiàn)報(bào)告如下。

1 資料與方法

1.1一般資料 選取2015年3～9月本院收治的40例單側(cè)全膝關(guān)節(jié)置換術(shù)患者,其中男18例,女22例,年齡60～85歲,40例患者隨機(jī)分為A、B組,各20例。

1.2方法 A、B兩組患者均在全身麻醉下完成手術(shù)。A組患者在全身麻醉后,采用高頻超聲探頭,于患肢腹股溝水平探測(cè)股神經(jīng)、股動(dòng)脈、股靜脈解剖結(jié)構(gòu)。采用平面外法進(jìn)針,在股神經(jīng)周圍注射0.6%甲磺酸羅哌卡因15～20 ml,注射過(guò)程中按壓注射處遠(yuǎn)端,使局部麻醉藥向股神經(jīng)上部擴(kuò)充開(kāi)來(lái),在此基礎(chǔ)上置入神經(jīng)阻滯術(shù)后鎮(zhèn)痛導(dǎo)管,固定于患者腹部皮膚處,連接術(shù)后鎮(zhèn)痛泵：0.3%甲磺酸羅哌卡因(240 ml,5 ml/h)。B組患者采用目前常使用的靜脈自控鎮(zhèn)痛技術(shù)：舒芬太尼2 μg/kg+托烷司瓊0.2 mg/kg(100 ml,2 ml/h)。術(shù)后疼痛劇烈者給予鹽酸地佐辛注射液5 mg肌內(nèi)注射。

1.3觀察指標(biāo) 觀察A、B兩組患者術(shù)后2、4、12、24、48 h的VAS疼痛評(píng)分,術(shù)后各時(shí)間點(diǎn)患肢肌力分析,術(shù)后患者不良反應(yīng)發(fā)生率。

1.4統(tǒng)計(jì)學(xué)方法 采用SPSS16.0統(tǒng)計(jì)學(xué)軟件處理數(shù)據(jù)。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

A組2、4、12、24、48 h VAS評(píng)分(1.7±0.8)、(2.2±0.8)、(2.2±0.6)、(2.0±0.7)、(1.6±0.5)分低于B組(5.5±1.4)、(4.5±1.1)、(3.8±1.4)、(2.7±0.7)、(2.2±0.7)分,差異均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。A組2、4、12、24、48 h肌力評(píng)分分別為(1.9±0.8)、(2.5±0.6)、(3.0±0.6)、(3.2±0.6)、(3.7±0.5)分；B組分別為(2.5±0.5)、(3.1±0.4)、(3.4±0.5)、(3.4±0.5)、(3.8±0.4)分；A組2、4、12 h下肢肌力評(píng)分低于B組(P＜0.05),24、48 h兩組下肢肌力評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。B組患者術(shù)后惡心、嘔吐共8例,A組患者術(shù)后惡心、嘔吐共2例,B組患者術(shù)后惡心、嘔吐發(fā)生率40%高于A組10%,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。

3 討論

現(xiàn)代人生活水平提升快速,醫(yī)療發(fā)展迅猛。膝關(guān)節(jié)置換術(shù)術(shù)后疼痛強(qiáng),會(huì)引起患者血壓上升,引發(fā)并發(fā)癥,所以需要進(jìn)行鎮(zhèn)痛治療,以往使用靜脈自控鎮(zhèn)痛,操作簡(jiǎn)單,但是有惡心、嘔吐的幾率。超聲引導(dǎo)連續(xù)股神經(jīng)阻滯的鎮(zhèn)痛效果好,安全性高,可以讓局部麻醉藥持續(xù)的擴(kuò)散,減少身體副作用,患者滿意度較高［5,6］。

總之,和傳統(tǒng)的靜脈自控鎮(zhèn)痛方式相比,超聲引導(dǎo)連續(xù)股神經(jīng)阻滯鎮(zhèn)痛應(yīng)用于全膝關(guān)節(jié)置換術(shù)術(shù)后鎮(zhèn)痛的效果更加突出,術(shù)后不良反應(yīng)發(fā)生率較低,臨床中應(yīng)該進(jìn)行推廣使用。

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Brief investigation by observing effect of ultrasound-guided continuous femoral nerve block for postoperative analgesia in total knee replacement

GUO Wei,WANG Li-li,WANG Si-ming.Daqing Oilfield General Hospital,Daqing 163000,China

ObjectiveTo investigate analgesic effect by ultrasound-guided continuous femoral nerve block in total knee replacement.MethodsA total of 40 patients receiving unilateral total knee replacement were randomly divided into group A and group B,with 20 cases in each group.Group A received ultrasound-guided continuous femoral nerve block for analgesia,and group B received patient-controlled intravenous analgesia.They all received operation under general anesthesia.Analgesic effects were compared between the two groups.ResultsGroup A had all lower visual analog scale (VAS) scores in postoperative 2,4,12,24 and 48 h than group B(P＜0.05).Group A had lower limb muscle force scores than group B in postoperative 2,4,12 h(P＜0.05),while their difference in 24 and 48 h had no statistical significance(P＞0.05).Incidence of postoperative nausea and emesis was higher in group B as 40% than 10% in group A(P＜0.05).ConclusionUltrasound-guided continuous femoral nerve block is better than conventional patient-controlled analgesia for postoperative analgesia in total knee replacement,along with low incidence of adverse reactions.This method is worth clinical promotion and application.

Total knee replacement; Ultrasound-guided; Continuous femoral nerve block; Postoperative analgesia

10.14164/j.cnki.cn11-5581/r.2016.17.024

2016-08-08］

163000 大慶油田總醫(yī)院