CAJ | 학술논문

选择美国麻醉医生协会(ASA)患者评级Ⅰ～Ⅱ级拟行单侧全膝关节置换患者60例，所有患者均在蛛网膜下腔麻醉和硬膜外联合麻醉后在神经刺激器引导下置入股神经导管，根据术后造影结果将导管位置分为腰肌组（18例）、髂肌组（19例）和局部组（23例）。记录术后4、24和48 h患者的静止和运动视觉模拟评分(VAS)，检查术后24h患者股神经、闭孔神经、股外侧皮神经的阻滞情况。术后3组股神经阻滞效果差异无统计学意义；闭孔神经阻滞腰肌组明显高于髂肌组和局部组，局部组高于髂肌组；股外侧皮神经阻滞腰肌组、髂肌组差异无统计学意义，但均明显高于局部组；术后4h腰肌组静息VAS评分明显优于其他两组，运动VAS评分3组差异无统计学意义。术后24、48 h腰肌组静止、运动VAS评分均明显优于另外两组，差异有统计学意义。
선택미국마취의생협회(ASA)환자평급Ⅰ～Ⅱ급의행단측전슬관절치환환자60례，소유환자균재주망막하강마취화경막외연합마취후재신경자격기인도하치입고신경도관，근거술후조영결과장도관위치분위요기조（18례）、가기조（19례）화국부조（23례）。기록술후4、24화48 h환자적정지화운동시각모의평분(VAS)，검사술후24h환자고신경、폐공신경、고외측피신경적조체정황。술후3조고신경조체효과차이무통계학의의；폐공신경조체요기조명현고우가기조화국부조，국부조고우가기조；고외측피신경조체요기조、가기조차이무통계학의의，단균명현고우국부조；술후4h요기조정식VAS평분명현우우기타량조，운동VAS평분3조차이무통계학의의。술후24、48 h요기조정지、운동VAS평분균명현우우령외량조，차이유통계학의의。
We enrolled 60 patients with American Association of Anesthesiologists grade Ⅰ - Ⅱ undergoing unilateral total knee arthroplasty. All patients received combined epidural and spinal anesthesia,and a nerve stimulator was used to guide placement of a femoral nerve catheter. Patients were divided into three groups according to the catheter location on X-ray : psoas muscle group ( n = 18 ), iliacus muscle group (n = 19) and local group (n =23). Visual analog scale (VAS) pain scores were recorded at rest and with movement at 4, 24 and 48 h postoperatively and sensory blockade of the femoral, obturator and lateral femoral cutaneous nerves was recorded at 24 h. There were no significant differences in femoral nerve blockade among the three groups. Obturator nerve blockade was significantly better in the psoas muscle group than in the iliacus muscle and local groups, and was also better in the local group than in the iliacus muscle group. There was no significant difference in lateral femoral cutaneous nerve blockade between the psoas muscle and iliacus muscle groups, but there was better blockade in both these groups than in the local group. At 4 h postoperatively, VAS pain scores at rest were significantly lower in the psoas muscle group than in the iliacus muscle and local groups, but there were no significant differences in VAS pain scores with movement among the three groups. At 24 and 48 h postoperatively, VAS scores at rest and with movement were significantly lower in the psoas muscle group than in the iliacus muscle and local groups.