中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2015年
6期
410-414
,共5页
shamrock method%超声%腰骶丛%自主神经传导阻滞%股神经%老年人%关节成形术,置换,膝%术后镇痛
shamrock method%超聲%腰骶叢%自主神經傳導阻滯%股神經%老年人%關節成形術,置換,膝%術後鎮痛
shamrock method%초성%요저총%자주신경전도조체%고신경%노년인%관절성형술,치환,슬%술후진통
shamrock method%ultrasound%lumbosacral plexus%autonomic nerve blocks%femoral nerve%aged%arthroplasty,replacement,knee%postoperative analgesia
目的：评价“Shamrock method”超声引导联合刺激仪定位下连续腰丛神经阻滞与连续股神经阻滞对全膝关节置换术后镇痛的临床效果。方法采用开放、随机对照的研究方法，选择解放军总医院2014年6月至2014年12月择期行单侧全膝关节置换术的老年患者80例，年龄65～87岁，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，随机均分为连续腰丛神经阻滞组（L组）和连续股神经阻滞组（F组）。L组患者采用“Shamrock method”超声引导联合刺激仪定位下行腰丛神经阻滞，F组则采用超声引导联合刺激仪定位下行股神经阻滞，两组穿刺成功后均注入0.2%罗哌卡因30ml并留置导管,术后镇痛泵背景剂量为0.2%罗哌卡因5ml/h。记录术后6，12，24，48h时静息状态视觉模拟评分法（VAS）评分，术后24，48h膝关节功能锻炼时VAS评分和肌力评分；记录术后局麻药中毒、恶心呕吐和神经损伤等不良反应的发生情况。结果与L组相比较，F组术后各时点静息状态和功能锻炼VAS评分均明显增高（P＜0.05），肌力评分两组间差异无统计学意义（P＞0.05）。两组均未见局麻药中毒、神经损伤发生，且恶心呕吐等不良反应发生率两组间差异无统计学意义。结论“Shamrock method”超声引导联合刺激仪定位下连续腰丛神经阻滞对于老年患者全膝关节置换术后镇痛的临床效果优于连续股神经阻滞。
目的：評價“Shamrock method”超聲引導聯閤刺激儀定位下連續腰叢神經阻滯與連續股神經阻滯對全膝關節置換術後鎮痛的臨床效果。方法採用開放、隨機對照的研究方法，選擇解放軍總醫院2014年6月至2014年12月擇期行單側全膝關節置換術的老年患者80例，年齡65～87歲，美國痳醉醫師協會（ASA）分級Ⅱ～Ⅲ級，隨機均分為連續腰叢神經阻滯組（L組）和連續股神經阻滯組（F組）。L組患者採用“Shamrock method”超聲引導聯閤刺激儀定位下行腰叢神經阻滯，F組則採用超聲引導聯閤刺激儀定位下行股神經阻滯，兩組穿刺成功後均註入0.2%囉哌卡因30ml併留置導管,術後鎮痛泵揹景劑量為0.2%囉哌卡因5ml/h。記錄術後6，12，24，48h時靜息狀態視覺模擬評分法（VAS）評分，術後24，48h膝關節功能鍛煉時VAS評分和肌力評分；記錄術後跼痳藥中毒、噁心嘔吐和神經損傷等不良反應的髮生情況。結果與L組相比較，F組術後各時點靜息狀態和功能鍛煉VAS評分均明顯增高（P＜0.05），肌力評分兩組間差異無統計學意義（P＞0.05）。兩組均未見跼痳藥中毒、神經損傷髮生，且噁心嘔吐等不良反應髮生率兩組間差異無統計學意義。結論“Shamrock method”超聲引導聯閤刺激儀定位下連續腰叢神經阻滯對于老年患者全膝關節置換術後鎮痛的臨床效果優于連續股神經阻滯。
목적：평개“Shamrock method”초성인도연합자격의정위하련속요총신경조체여련속고신경조체대전슬관절치환술후진통적림상효과。방법채용개방、수궤대조적연구방법，선택해방군총의원2014년6월지2014년12월택기행단측전슬관절치환술적노년환자80례，년령65～87세，미국마취의사협회（ASA）분급Ⅱ～Ⅲ급，수궤균분위련속요총신경조체조（L조）화련속고신경조체조（F조）。L조환자채용“Shamrock method”초성인도연합자격의정위하행요총신경조체，F조칙채용초성인도연합자격의정위하행고신경조체，량조천자성공후균주입0.2%라고잡인30ml병류치도관,술후진통빙배경제량위0.2%라고잡인5ml/h。기록술후6，12，24，48h시정식상태시각모의평분법（VAS）평분，술후24，48h슬관절공능단련시VAS평분화기력평분；기록술후국마약중독、악심구토화신경손상등불량반응적발생정황。결과여L조상비교，F조술후각시점정식상태화공능단련VAS평분균명현증고（P＜0.05），기력평분량조간차이무통계학의의（P＞0.05）。량조균미견국마약중독、신경손상발생，차악심구토등불량반응발생솔량조간차이무통계학의의。결론“Shamrock method”초성인도연합자격의정위하련속요총신경조체대우노년환자전슬관절치환술후진통적림상효과우우련속고신경조체。
ObjectiveTo evaluate the efficacy of the“Shamrock method”,ultrasound combined withstimulator guided continuous lumbar plexus nerve blockfor postoperative analgesia intheelderlyafter total knee arthroplastyby compared with continuous femoral nerve block.MethodsAn open, randomized, controlled trial was conducted on 80 ASAⅡ orⅢ patients (65 to 87 years old) undergoing total knee arthroplasty in our hospital from June to December 2014. The patients were randomly assigned to continuous lumbar plexus nerve block group (L group) and continuous femoral nerve block group (F group).The patients of the formergroupreceived continuous lumbar plexus nerve blockby ultrasound guided“shamrock” and electronic nervestimulator,and those of the latter group receivedcontinuous femoral nerve block byultrasound guiding combined withstimulator.After the nerve block catheters were inserted and30ml 0.2% ropivacaine was given,allpatients receivedpatient-controlled analgesia(PCA) after the surgery with0.2%ropivacaine 5ml/has the background dose. VisualAnalogueScale (VAS) wasemployed to evaluate the pain level at 6,12,24 and48h, postoperatively. VASpain scores were recorded at 24 and48h, postoperatively, during functional excise and muscle strength.The toxic reaction,nausea and vomiting, and nerve damage were recorded after surgery.Results TheVASscores during rest and functional excise weresignificantly higher inFgroupthanin Lgroup (P<0.05), but there was no difference in the muscle strength between the2 groups (P>0.05).Nolocal anesthetic toxicityor nerve damage was founded inthe both groups, and there was no statisticaldifference in the incidence of side effect such as nausea and vomiting during postoperative analgesia. Conclusion The ultrasound-guided“shamrock” combined withstimulatorforcontinuous lumbar plexus nerve block issuperior to continuous femoral nerve block in analgesiafor postoperative analgesiain the elderlyaftertotal knee arthroplasty.
