下肢神经阻滞对矫形手术术后早期康复的影响

Effect of Nerve Block on Early Rehabilitation after Lower Limb Orthopedic Surgery

目的探讨超声引导下神经阻滞和腰硬联合麻醉分别对下肢矫形手术术后早期康复的影响。方法择期行下肢矫形手术的患者80例,随机分为神经阻滞(A)组和腰硬联合麻醉(B)组,各40例。记录两组手术时间、出血量,患者术后2h、4h、6h、8h、12h、24h、48hVAS评分及不良反应发生例数,术后半卧位、在床活动时间和早期进流质饮食时间。结果两组患者手术时间、出血量差异无统计学意义(P>0.05),两组患者术后2h、4h、6h、8h、12h、24hVAS评分无显著差异(P>0.05),但术后48hB组VAS评分显著低于A组(P<0.05);A组与B组比较,A组术后无头痛发生,无全身皮肤瘙痒和排尿困难或尿潴留的现象(P<0.05);A组与B组比较,两组术后低血压、恶心、呕吐发生率无显著差异(P>0.05)。A组较B组从术毕到半卧位、在床活动时间和进流质饮食时间均明显要早,差异有统计学意义(P<0.05)。结论超声引导下神经阻滞可加速下肢矫形手术患者早期康复。

Objective To investigate the effect of ultrasound-guided nerve block and combined spinal-epidural anesthesia on early rehabilitation after lower limb orthopedic surgery. Methods Chose 80 patients underwent lower limb orthopedic surgery who were randomLy divided into nerve block (A) group and combined spinal-epidural anesthesia (B) group, 40 cases for each group. The operation time, bleeding volume, VAS scores at 2, 4, 6, 8, 12, 24, 48 hours and the cases of adverse reactions ,the time of half-lying position, bed-time and early fluids intake time were recorded after operation. Results There was no statistical significance in operation time and bleeding volume between the two groups(P > 0.05). There was no significant difference in VAS score between the two groups at 2, 4, 6, 8, 12 and 24 hours after operation(P > 0.05). The VAS score in group Bwas significantly lower than that in group A at 48 hours after operation(P < 0.05). Compared group A with group B,there was no headache, itching, dysuria or urinary retention after operation in group A (P < 0.05);There was no significant difference in the incidence rate of hypotension, nausea and vomiting between the two groups(P > 0.05). Group A was earlier than group B in terms of the time from the end of operation to the half-lying position, the bed time and the time of intake of liquid diet, and the difference was statistically significant(P < 0.05). Conclusion Ultrasound-guided nerve block can accelerate the early rehabilitation of patients undergoing lower limb orthopaedic surgery.