CAJ | 학술논문

目的：评价连续股神经阻滞联合浸润麻醉用于全膝关节置换术患者术后镇痛的效果。方法择期拟行单侧全膝关节置换术患者90例，ASA分级Ⅰ?Ⅲ级，年龄50～80岁，体重45～90 kg。采用随机数字表法，将患者分为3组（ n＝30）：连续股神经阻滞＋浸润麻醉组（ A组）、连续股神经阻滞组（B组）、连续股神经阻滞＋单次坐骨神经阻滞组（C组）。3组麻醉诱导前均放置股神经阻滞导管，之后C组行单次坐骨神经阻滞。 A组上假体之前，在关节囊后部注射混合药物20 ml，上完假体缝合之前，左右侧副韧带及切口处注射混合药物20 ml。混合药物为罗哌卡因2．5 mg∕ml、芬太尼2．5μg∕ml、甲泼尼龙琥珀酸钠1 mg∕ml。 B组依照上述方法注射生理盐水40 ml。术后行PCA，镇痛药物为0．2％罗哌卡因250 ml，背景输注速率5 ml∕h，PCA剂量5 ml，锁定时间30 min，持续镇痛48 h。采用口服曲马多进行补救镇痛，维持VAS评分≤5分。于术后4、8、12、24、48 h时记录静态VAS评分，于术后8、12、24、48 h时记录动态VAS评分。记录术后48 h内曲马多用量。于术后12、24、48 h时评价患肢运动功能，拔除股神经阻滞导管后72 h时评价患肢感觉和运动功能。记录置管处渗血∕液情况和不良反应的发生情况。结果与B组或C组比较，A组术后4～24 h时静态VAS评分、术后8～24 h动态VAS评分降低，曲马多用量降低（P＜0．05）；与B组比较，A组术后各时点患肢运动阻滞评分差异无统计学意义（ P＞0．05）；与C组比较，A组和B组术后12 h时患肢运动阻滞评分降低（ P＜0．05）。3组患者置管处渗血∕液、恶心呕吐发生率比较差异无统计意义（ P＞0．05）。结论连续股神经阻滞联合浸润麻醉可为全膝关节置换术患者提供更加充分的术后镇痛效果，且不影响感觉和运动功能恢复，安全性较好。目的：評價連續股神經阻滯聯閤浸潤痳醉用于全膝關節置換術患者術後鎮痛的效果。方法擇期擬行單側全膝關節置換術患者90例，ASA分級Ⅰ?Ⅲ級，年齡50～80歲，體重45～90 kg。採用隨機數字錶法，將患者分為3組（ n＝30）：連續股神經阻滯＋浸潤痳醉組（ A組）、連續股神經阻滯組（B組）、連續股神經阻滯＋單次坐骨神經阻滯組（C組）。3組痳醉誘導前均放置股神經阻滯導管，之後C組行單次坐骨神經阻滯。 A組上假體之前，在關節囊後部註射混閤藥物20 ml，上完假體縫閤之前，左右側副韌帶及切口處註射混閤藥物20 ml。混閤藥物為囉哌卡因2．5 mg∕ml、芬太尼2．5μg∕ml、甲潑尼龍琥珀痠鈉1 mg∕ml。 B組依照上述方法註射生理鹽水40 ml。術後行PCA，鎮痛藥物為0．2％囉哌卡因250 ml，揹景輸註速率5 ml∕h，PCA劑量5 ml，鎖定時間30 min，持續鎮痛48 h。採用口服麯馬多進行補救鎮痛，維持VAS評分≤5分。于術後4、8、12、24、48 h時記錄靜態VAS評分，于術後8、12、24、48 h時記錄動態VAS評分。記錄術後48 h內麯馬多用量。于術後12、24、48 h時評價患肢運動功能，拔除股神經阻滯導管後72 h時評價患肢感覺和運動功能。記錄置管處滲血∕液情況和不良反應的髮生情況。結果與B組或C組比較，A組術後4～24 h時靜態VAS評分、術後8～24 h動態VAS評分降低，麯馬多用量降低（P＜0．05）；與B組比較，A組術後各時點患肢運動阻滯評分差異無統計學意義（ P＞0．05）；與C組比較，A組和B組術後12 h時患肢運動阻滯評分降低（ P＜0．05）。3組患者置管處滲血∕液、噁心嘔吐髮生率比較差異無統計意義（ P＞0．05）。結論連續股神經阻滯聯閤浸潤痳醉可為全膝關節置換術患者提供更加充分的術後鎮痛效果，且不影響感覺和運動功能恢複，安全性較好。
목적：평개련속고신경조체연합침윤마취용우전슬관절치환술환자술후진통적효과。방법택기의행단측전슬관절치환술환자90례，ASA분급Ⅰ?Ⅲ급，년령50～80세，체중45～90 kg。채용수궤수자표법，장환자분위3조（ n＝30）：련속고신경조체＋침윤마취조（ A조）、련속고신경조체조（B조）、련속고신경조체＋단차좌골신경조체조（C조）。3조마취유도전균방치고신경조체도관，지후C조행단차좌골신경조체。 A조상가체지전，재관절낭후부주사혼합약물20 ml，상완가체봉합지전，좌우측부인대급절구처주사혼합약물20 ml。혼합약물위라고잡인2．5 mg∕ml、분태니2．5μg∕ml、갑발니룡호박산납1 mg∕ml。 B조의조상술방법주사생리염수40 ml。술후행PCA，진통약물위0．2％라고잡인250 ml，배경수주속솔5 ml∕h，PCA제량5 ml，쇄정시간30 min，지속진통48 h。채용구복곡마다진행보구진통，유지VAS평분≤5분。우술후4、8、12、24、48 h시기록정태VAS평분，우술후8、12、24、48 h시기록동태VAS평분。기록술후48 h내곡마다용량。우술후12、24、48 h시평개환지운동공능，발제고신경조체도관후72 h시평개환지감각화운동공능。기록치관처삼혈∕액정황화불량반응적발생정황。결과여B조혹C조비교，A조술후4～24 h시정태VAS평분、술후8～24 h동태VAS평분강저，곡마다용량강저（P＜0．05）；여B조비교，A조술후각시점환지운동조체평분차이무통계학의의（ P＞0．05）；여C조비교，A조화B조술후12 h시환지운동조체평분강저（ P＜0．05）。3조환자치관처삼혈∕액、악심구토발생솔비교차이무통계의의（ P＞0．05）。결론련속고신경조체연합침윤마취가위전슬관절치환술환자제공경가충분적술후진통효과，차불영향감각화운동공능회복，안전성교호。
Objective To evaluate the effects of continuous femoral nerve block combined with in?filtration anesthesia on postoperative analgesia in the patients undergoing total knee arthroplasty. Methods Ninety patients, aged 50-80 yr, weighing 45-90 kg, of ASA physical status Ⅰ-Ⅲ, scheduled for elective unilateral total knee arthroplasty, were randomly divided into 3 groups ( n=30 each) using a ran?dom number table: continuous femoral nerve block + infiltration anesthesia group ( group A); continuous femoral nerve block group ( group B); continuous femoral nerve block + single sciatic nerve block group ( group C) . The femoral nerve was catheterized for block before induction of general anesthesia in the three groups, and then a single sciatic nerve block was performed in group C. In group A, 20 ml mixture was in?jected into the posterior part of the joint capsule before prosthesis implantation, and 20 ml mixture was in?jected around the collateral ligaments and incision sites after prosthesis implantation and before closing. The mixture included ropivacaine 2?5 mg∕ml, fentanyl 2?5 μg∕ml, and methylprednisolone 1 mg∕ml. In group B, 40 ml of normal saline was given as the method previously described in group A. Patient?controlled anal?gesia with 0?2% ropivacaine 250 ml was used for postoperative analgesia, lasting for 48 h. The patient?con?trolled analgesia pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml∕h. Tramadol was used as rescue analgesic and was given orally to maintain the VAS score ≤ 5. VAS scores at rest were recorded at 4, 8, 12, 24 and 48 h after surgery, and VAS scores during activity were recorded at 8, 12, 24 and 48 h after surgery. The total consumption of tramadol within 48 h after surgery was recorded. The motor function of the affected extremity was assessed and scored at 12, 24 and 48 h after surgery, and the sensory and motor function was evaluated at 72 h after removal of the catheter. The occurrence of bleeding or exudates from the site of catheterization and adverse effects were recorded. Results Compared with group B or C, VAS scores at rest at 4-24 h after operation, VAS scores during activity at 8-24 h after operation, and the total consumption of tramadol were significantly de?creased in group A. Compared with group B, no significant changes were found in motor block score of the affected extremity in group A. Compared with group C, the motor block score of the affected extremity was significantly decreased in A and B groups. There were no significant differences in the incidence of bleeding or exudates from the site of catheterization and nausea and vomiting between the three groups. Conclusion Continuous femoral nerve block combined with infiltration anesthesia can provide sufficient analgesia with?out influencing the recovery of sensory and motor function, and the safety is good for the patients undergoing total knee arthroplasty.