不同神经阻滞方式对膝关节镜下半月板切除术患者的临床疗效分析

Clinical effect analysis of different nerve block methods on patients undergoing knee arthroscopic meniscus resection

目的分析不同神经阻滞方式对膝关节镜下半月板切除术患者的临床疗效。方法选取2018年2月至2021年9月在成都市第二人民医院进行膝关节镜下半月板切除术的86例膝骨关节炎患者为研究对象,采用随机数字表法分为对照组与观察组,每组各43例。对照组采取股神经阻滞,观察组采取收肌管阻滞。比较分析两组患者的麻醉相关指标(麻醉操作时间、麻醉起效时间及阻滞成功率),手术前后的血流动力学指标(收缩压、舒张压和心率)和股四头肌肌力,术后疼痛程度以及不良反应发生情况。结果两组患者的麻醉操作时间、麻醉起效时间、阻滞成功率和术后不良反应发生情况比较差异均无显著性(P>0.05)。穿刺前10min、术毕,两组患者的收缩压、舒张压和心率比较差异均无显著性(P>0.05)。术后6h,两组患者的股四头肌肌力均显著低于穿刺前10min(P<0.05),且对照组显著低于观察组(P<0.05);观察组患者的静息状态、被动运动和主动运动时的视觉模拟评分法评分均显著低于对照组(P<0.05)。结论两种神经阻滞方式对膝关节镜下半月板切除术患者均有较好的阻滞效果,但收肌管阻滞的术后镇痛效果更佳,且对患者的股四头肌肌力影响更小。

Objective To analyze the clinical effects of different nerve block methods on patients undergoing knee arthroscopic meniscus resection.Method 86 patients who underwent knee arthroscopic meniscus resection in Chengdu Second People’s Hospital from February 2018 to September 2021 were selected.The patients were divided into the control group and the observation group by random number table method,with 43 cases in each group.The control group received femoral nerve block,and observation group performed adductor tube block.Anesthesia related indexes,hemodynamic indexes and quadriceps muscle strength before and after surgery,postoperative pain degree and incidence of adverse reactions were compared and analyzed between the two groups.Result There were no significant differences in anesthesia operation time,anesthesia effective time,success rate of block and postoperative adverse reactions between two groups(P>0.05).There were no significant differences in systolic blood pressure,diastolic blood pressure and heart rate between two groups 10min before puncture and after operation(P>0.05).6h after operation,the muscle strength of quadriceps femoris in two groups was significantly lower than 10min before puncture(P<0.05),and the control group was significantly lower than the observation group(P<0.05).The VAS scores of the observation group during resting state,passive exercise and active exercise were significantly lower than those of the control group(P<0.05).Conclusion Two nerve block methods have good blocking effect for knee arthroscopic meniscus resection,but adductor tube block has better postoperative analgesia effect and less influence.