控制性降压联合股神经阻滞全膝关节置换

Controlled hypotension combined with femoral nerve block for total knee arthroplasty

[目的]观察控制性降压联合股神经阻滞下全膝关节置换(total knee arthroplasty,TKA)的临床效果。[方法]2016年1月~2018年5月,149例拟行单侧TKA患者纳入本研究,采用随机数字表法将患者分为两组。其中,控制血压组75例采用喉罩全麻和股神经阻滞,短时间使用止血带下TKA;常规组74例采用硬腰麻醉,全程使用止血带下TKA,比较两组患者一般临床资料、术后早期不良反应和失血相关指标。[结果]两组患者均顺利完成手术,无严重术中并发症。术中控制血压组控压期间收缩压、舒张压均显著低于常规组。控制血压组术后24、48 h的VAS评分均显著小于常规组(P<0.05)。术后48、72 h两组间术后MoCA评分差异均无统计学意义(P>0.05)。控制血压组术后恶心呕吐、低血压、止血带疼痛、肢体肿胀、小腿麻木的发生率显著低于常规组(P<0.05)。控制血压组术后48 h隐性失血量、总失血量与常规组比较,差异无统计学意义(P>0.05)。[结论]控制性降压联合股神经阻滞能够减少TKA止血带使用时间,减少早期不良反应,不增加围手术期出血量。

[Objective]To evaluate the clinical outcomes of controlled hypotension combined with femoral nerve block for total knee ar⁃throplasty(TKA)with limited tourniquet.[Methods]From January 2016 to May 2018,a total of 149 patients who were undergoing primary unilateral TKA were enrolled in this study and divided into two groups by random table method.Of them,75 patients in the controlled hypo⁃tension(CH)group received laryngeal mask general anesthesia,controlled hypotension and femoral nerve block for TKA with tourniquet used in short time,while 74 patients in the conventional group underwent spinal and epidural anesthesia for TKA with tourniquet used whole operation.The general clinical data,adverse reactions and documents related to blood loss were compared between the two groups.[Results]All the patients had operation performed smoothly without serious intraoperative complications.The CH group had significantly lower systolic blood pressure and diastolic blood pressure than the conventional group during controlled hypotension period(P<0.05),and the former had significantly shorter time to use tourniquet than the latter(P<0.05).The CH group got significantly less VAS score than the conventional group(P<0.05),nevertheless no a statistical difference in MoCA score was found between the two groups at 24 and 48 hours postoperatively(P>0.05).The CH group had significantly lower incidence of nausea,vomiting,low blood pressure,thigh pain,limb swell⁃ing and calf numbness than the conventional group at early stage after operation(P<0.05).In addition,the CH group proved significantly lower postoperative hidden blood loss than the conventional group 48 hours after operation(P<0.05),despite of the fact that no a statistical difference in total blood loss was noticed between the two group(P>0.05).[Conclusion]This controlled hypotension combined with femo⁃ral nerve block does shorten the time of tourniquet used,with considerable declining adverse reaction,without increasing perioperative blood loss in primary unilateral total knee arthroplasty.