超声引导神经阻滞联合全身麻醉在全膝关节置换术患者中的应用效果

Application effect of ultrasound-guided nerve block combined with general anesthesia in patients undergoing total knee arthroplasty

目的探讨超声引导神经阻滞联合全身麻醉在全膝关节置换术(TKA)患者中的应用效果,以为手术医师选择合理的麻醉方式提供参考和借鉴。方法选取2019年1月至2020年1月在我院接受TKA的98例患者作为研究对象,根据麻醉方式将其分为对照组和观察组,各49例。对照组采用全身麻醉,观察组采用超声引导神经阻滞联合全身麻醉。比较两组的镇静、镇痛效果及不同时间点的应激反应指标、谵妄发生情况、膝关节活动度。结果观察组麻醉后30 min的RSS评分高于对照组,术后12、24、48 h的静息VAS评分低于对照组,差异具有统计学意义(P<0.05)。麻醉前,两组的SP、Cor、血糖水平无显著差异(P>0.05);麻醉苏醒期,两组的SP、Cor、血糖水平均升高,但观察组低于对照组,差异具有统计学意义(P<0.05)。麻醉前,两组的CAM评分无显著差异(P>0.05);麻醉后6、24 h,两组的CAM评分均升高,但观察组低于对照组,差异具有统计学意义(P<0.05)。术后24、48、72 h,观察组主动运动及被动运动时的膝关节活动度均大于对照组,差异具有统计学意义(P<0.05)。结论超声引导神经阻滞联合全身麻醉应用于TKA中,可提高镇静、镇痛效果,减轻麻醉苏醒期应激反应,改善谵妄发生情况及膝关节活动度,值得临床推广和应用。

Objective To investigate the application effect of ultrasound-guided nerve block combined with general anesthesia in patients undergoing total knee arthroplasty(TKA),so as to provide reference for surgeons to choose reasonable anesthesia mode.Methods A total of 98 patients who received TKA in our hospital from January 2019 to January 2020 were selected as the research objects.The patients were divided into control group and observation group according to anesthesia mode,with 49 cases in each group.The control group adopted general anesthesia,and the observation group adopted ultrasound-guided nerve block combined with general anesthesia.The sedative and analgesic effects,stress response indexes,delirium occurrence and range of motion of knee joint at different time points were compared between the two groups.Results The RSS score at 30 min after anesthesia in the observation group was higher than that in the control group,and the resting VAS score at 12,24 and 48 h after operation was lower than that in the control group,the differences were statistically significant(P<0.05).Before anesthesia,there were no significant differences in SP,Cor and blood glucose levels between the two groups(P>0.05);at anesthesia recovery period,SP,Cor and blood glucose levels in the two groups increased,but those in the observation group were lower than the control group,the differences were statistically significant(P <0.05).Before anesthesia,there was no significant difference in CAM score between the two groups(P>0.05);at 6 and 24 h after anesthesia,the CAM score of the two groups increased,but that of the observation group was lower than the control group,the differences were statistically significant(P<0.05).At 24,48 and 72 h after operation,range of motion of knee joint of active motion and passive motion in the observation group were greater than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided nerve block combined with general anesthesia applied in TKA can improve the sedative and analgesic effects,reduce the stress response at anesthesia recovery period,and ameliorate the delirium occurrence and range of motion of knee joint,which is worthy of clinical promotion and application.