超声引导下连续腰交感神经节阻滞联合全麻对膝关节置换术患者镇痛及苏醒质量的影响

doi:10.7517/issn.1674-0475.190526

摘要/Abstract

摘要： 本文对超声引导下连续腰交感神经节阻滞联合全麻对膝关节置换术患者镇痛及苏醒质量的影响进行了分析和探讨。选取2017年1月～2019年1月本院膝关节置换术患者100例，依据随机数字表分为滞麻组和单麻组，每组50例，单麻组给予单纯全麻，滞麻组在此基础上给予超声引导下连续腰交感神经节阻滞，比较两组镇痛及苏醒质量、不良反应。结果显示，滞麻组切皮时（T1）、关节置换时（T2）、术毕（T3）的平均动脉压（MAP）、心率（HR）明显低于单麻组，滞麻组镇痛优良率明显高于单麻组，有统计学差异（P<0.05）；滞麻组呼之睁眼、呼之握拳、拔管、苏醒时间和苏醒并发症率明显低于单麻组，有统计学差异（P<0.05）；滞麻组和单麻组不良反应率比较，无统计学差异（P>0.05）。本文认为，超声引导下连续腰交感神经节阻滞联合全麻可有效改善膝关节置换术患者镇痛及苏醒质量，且安全性好，值得临床推广。

关键词: 超声引导, 连续腰交感神经节阻滞, 全麻, 膝关节置换术, 镇痛质量, 苏醒质量

Abstract: The effect of ultrasound-guided continuous lumbar sympathetic ganglion block combined with general anesthesia on the analgesia and recovery quality in patients undergoing knee arthroplasty was analyzed in this study. From January 2017 to January 2019, 100 patients with knee arthroplasty in our hospital were selected as the subjects of study, they were divided into anesthesia group and anesthesia group according to random number table, 50 cases in each group. The single anesthesia group was given general anesthesia, and the block anesthesia group was given continuous lumbar sympathetic ganglion block guided by ultrasound. The of analgesia and recovery quality, adverse reactions were compared between the two groups. The results showed that, the mean arterial pressure (MAP) and heart rate (HR) in the block anesthesia group at skin incision time (T1), knee arthroplasty time (T2), postoperatively (T3) were significantly lower in those in the anesthesia group, the anesthesia excellent rate in the block anesthesia group was significantly higher than in the anesthesia group, the difference was statistically significant (P<0.05). The amount of anesthetics, opening eyes, clenching, extubation, and awakening time and awakening complications rate in the block anesthesia group were significantly lower than those in the anesthesia group, the difference was statistically significant (P<0.05). The comparison of the adverse reaction rate between the block anesthesia group and the anesthesia group,the difference was no statistically significant (P>0.05). This study confirms that, ultrasound-guided continuous lumbar sympathetic ganglion block combined with general anesthesia can effectively improve the analgesia and recovery quality in patients undergoing knee arthroplasty, and it has the good safety, it's worth for further clinical promotion.

Key words: ultrasound-guided, continuous lumbar sympathetic ganglion block, general anesthesia, knee arthroplasty, analgesia quality, recovery quality

刘晓岚, 曹晓霞. 超声引导下连续腰交感神经节阻滞联合全麻对膝关节置换术患者镇痛及苏醒质量的影响[J]. 影像科学与光化学, 2019, 37(6): 591-597.

LIU Xiaolan, CAO Xiaoxia. The Effect of Ultrasound-guided Continuous Lumbar Sympathetic Ganglion Block Combined with General Anesthesia on the Analgesia and Recovery Quality in Patients Undergoing Knee Arthroplasty[J]. Imaging Science and Photochemistry, 2019, 37(6): 591-597.

参考文献

[1] 张钰,贾梦醒,刘功俭.持续隐神经阻滞联合全身麻醉在老年患者全膝关节置换术中的临床研究[J].徐州医学院学报, 2016,36(7):467-471. Zhang Y, Jia M X, Liu G J. A clinical study on continuous saphenous nerve block combined with general anesthesia for elderly patients during total knee arthroplasty[J].Acta Academiae Medicinae Xuzhou, 2016,36(7):467-471.
[2] Morales-Muñoz C, Sánchez-Ramos J L, Díaz-Lara M D, González-González J, Gallego-Alonso I, Hernández-Del-Castillo M S.Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after total knee replacement[J].Revista Española de Anestesiologíay Reanimación, 2017,64(1):19-26.
[3] 包萌萌,王云,马丹旭,利雪阳,张忱,岳云."三叶草"超声影像引导腰交感神经节阻滞的临床效果[J].中华麻醉学杂志, 2016,36(9):1130-1133. Bao M M, Wang Y, Ma D X, Li X Y, Zhang C, Yue Y. Clinical efficacy of "Shamrock" ultrasound images-guided lumbar sympathetic ganglion blockade[J].Chinese Journal of Anesthesilolgy, 2016,36(9):1130-1133.
[4] Yilmaz S, Ta? S, Tunca Yllmaz O.Comparison of median nerve mechanosensitivity and pressure pain Threshold in patients with nonspecific neck pain and asymptomatic individuals[J].Journal of Manipulative and Physiological Therapeutics, 2018,41(3):227-233.
[5] 宦乡,王立伟,王凯,周美艳.超声引导下髂筋膜间隙神经阻滞用于全膝关节置换术的镇痛效果及安全性评价[J].广西医科大学学报, 2018,35(9):1280-1282. Huan X, Wang L W, Wang K, Zhou M Y. Evaluation of analgesic effect and safety of ultrasound-guided iliofascial nerve block in total knee arthroplasty[J].Journal of Guangxi Medical University, 2018,35(9):1280-1282.
[6] Neogi T, Li S, Peloquin C, Misra D, Zhang Y.Effect of bisphosphonates on knee replacement surgery[J].Annals of the Rheumatic Diseases, 2018,77(1):92-97.
[7] 王秋平.股神经阻滞复合全身麻醉在老年全膝关节置换术中的应用效果分析[J].中国保健营养, 2017,27(9):106. Wang Q P. Application of femoral nerve block combined with general anesthesia in elderly total knee arthroplasty[J].China Health Care&Nutrition, 2017,27(9):106.
[8] Kim M K, Moon H Y, Ryu C G, Kang H, Lee H J, Shin H Y.The analgesic efficacy of the continuous adductor canal block compared to continuous intravenous fentanyl infusion with a single-shot adductor canal block in total knee arthroplasty:a randomized controlled trial[J].The Korean Journal of Pain, 2019,32(1):30-38.
[9] 毕阳.全麻联合双侧股神经阻滞麻醉对双膝关节置换术患者麻醉恢复期的影响[J].空军医学杂志, 2018,34(2):107-110. Bi Y. Effect of general anesthesia combined with bilateral femoral nerve block anesthesia on anesthesia recovery in patients under double knee arthroplasty[J].Journal of General Hospital of Air Force, PLA, 2018,34(2):107-110.
[10] Karkhur Y, Mahajan R, Kakralia A, Kakralia A, Pandey A P, Kapoor M C.A comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty:A systematic literature review[J].Journal of Anaesthesiology Clinical Pharmacology, 2018,34(4):433-438.
[11] 李登峰.下肢神经阻滞复合喉罩全麻在老年患者膝关节置换手术中应用观察[J].中国处方药, 2016,14(8):104-106. Li D F. Observation on the application of lower limb nerve block combined with laryngeal mask general anesthesia in knee arthroplasty in elderly patients[J].China Prescription Drug, 2016,14(8):104-106.
[12] Elkassabany N M, Cai L F, Badiola I, Kase B, Liu J, Hughes C, Israelite C L, Nelson C L.A prospective randomized open-label study of single injection versus continuous adductor canal block for postoperative analgesia after total knee arthroplasty[J].The Bone&Joint Journal, 2019,101-B (3):340-347.
[13] 张鸿滨.超声引导下连续腰交感神经节阻滞治疗下肢Buerger's病的顽固性疼痛的观察[J].双足与保健, 2018,27(2):107, 109. Zhang H B. Ultrasound-guided continuous lumbar sympathetic ganglion block for intractable pain in lower extremity Buerger's disease[J].China Reflexology, 2018,27(2):107, 109.
[14] Zhang J F, Wang X F, Zhang H, Shu Z L, Jiang W.Comparison of combined lumbar and sacral plexus block with sedation versus general anaesthesia on postoperative outcomes in elderly patients undergoing hip fracture surgery (CLSB-HIPELD):study protocol for a prospective, multicentre, randomised controlled trial[J].BMJ Open, 2019,9(3):e022898.
[15] 吴超,谢晓燕,胡李明,张娟.B超引导下椎旁阻滞与腰硬联合麻醉在无张力疝修补术中的效果比较[J].浙江医学, 2016,38(4):297-299. Wu C, Xie X Y, Hu L M, Zhang J. Comparison of B-mode ultrasound-guided paravertebral block and combined spinal-epidural anesthesia in tension-free hernioplasty[J].Zhejiang Medical Journal, 2016,38(4):297-299.
[16] Karmakar M K, Li J W, Kwok W H, Hadzic A.Ultrasound-guided lumbar plexus block using a transverse scan through the lumbar intertransverse space:a prospective case series[J].Regional Anesthesia&Pain Medicine, 2015,40(1):75-81.