序贯降阶梯式持续股神经阻滞在全膝关节置换患者中的应用

Application of sequential descending continuous femoral nerve block in patients undergoing total knee arthroplasty

目的探讨序贯降阶梯式持续股神经阻滞在全膝关节置换患者中的应用效果。方法选取2019年7月~2020年6月大连市友谊医院收治的80例腰硬联合麻醉下完成的全膝关节置换术患者作为研究对象,按照随机数字表法将其分为观察组与对照组,每组40例。观察组患者行序贯降阶梯式持续股神经阻滞,对照组患者行持续给药自控镇痛。比较治疗过程中两组患者的疼痛视觉模拟量表(VAS)评分、P物质(SP)水平、膝关节国际膝关节评分委员会(IKDC)评分及并发症发生情况。结果观察组患者术后12、24、48 h的疼痛VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组患者术后12、24、48 h的SP水平低于对照组,差异有统计学意义(P<0.05)。术后48 h,两组患者的膝关节IKDC评分均高于术后6 h,差异有统计学意义(P<0.05);观察组患者的膝关节IKDC评分高于对照组,差异有统计学意义(P<0.05)。观察组患者发生皮肤瘙痒、下肢麻木、便秘及血肿的总发生率低于对照组,差异有统计学意义(P<0.05)。结论针对全膝关节置换术患者,实施序贯降阶梯式股神经阻滞,能有效改善患者术后疼痛,提高膝关节功能,且并发症少,安全性高。

Objective To explore the application effect of sequential descending continuous femoral nerve block in patients undergoing total knee arthroplasty.Methods A total of 80 patients undergoing total knee arthroplasty under combined spinal and epidural anesthesia in Dalian Friendship Hospital from July 2019 to June 2020 were selected as the research objects and divided into the observation group and the control group according to random number table method,with 40 cases in each group.Patients in the observation group received sequential descending continuous femoral nerve block,and patients in the control group received continuous drug controlled analgesia.Visual analogue scale(VAS)score,substance P(SP)level,knee joint international knee scoring committee(IKDC)score and complications were compared between the two groups during treatment.Results The pain VAS scores of observation group were lower than those of the control group at 12,24 and 48 h after surgery,and the differences were statistically significant(P<0.05).The levels of SP in observation group were lower than those of the control group at 12,24 and 48 h after operation,and the differences were statistically significant(P<0.05).At 48 h after surgery,knee IKDC scores of the two groups were higher than those at 6 h after surgery,and the differences were statistically significant(P<0.05).The knee IKDC score of the observation group 48 h after surgery was higher than that of the control group,and the difference was statistically significant(P<0.05).The total incidence of skin itching,lower limb numbness,constipation and hematoma in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion For patients undergoing total knee arthroplasty,sequential descending femoral nerve block can effectively improve postoperative pain and knee function,with fewer complications and high safety.