股神经阻滞复合全身麻醉对老年膝关节置换术患者的术后镇痛效果观察

Postoperative analgesic effect of femoral nerve block combined with general anesthesia on elderly patients undergoing knee arthroplasty

目的探讨股神经阻滞复合全身麻醉对老年膝关节置换术患者的术后镇痛效果。方法回顾性纳入河南省洛阳正骨医院2016年1月至2020年12月收治的行膝关节置换术的老年患者200例,根据膝关节置换术的麻醉方法分为股神经阻滞复合全麻组(100例)和全麻组(100例)。比较两组患者术后不同时间段静息时和活动时疼痛程度,术后24 h应激指标和炎性因子,术后不良反应发生率。结果术后4、12、24、48 h,股神经阻滞复合全麻组患者静息时视觉模拟评分法(VAS)评分和活动时VAS评分均低于全麻组(P均<0.05);术后24 h,股神经阻滞复合全麻组患者空腹血糖、血清皮质醇水平、白细胞计数、C反应蛋白、白细胞介素1β和肿瘤坏死因子α水平均低于全麻组(P均<0.05);股神经阻滞复合全麻组患者术后不良反应发生率(7.00%,7/100)低于全麻组(23.00%,23/100),P<0.05。结论股神经阻滞复合全身麻醉用于老年膝关节置换术,具有较好的术后镇痛效果和较低的不良反应发生率,可以有效抑制机体的应激反应,减少炎症因子释放,安全性较高。

Objective To investigate the postoperative analgesic effect of femoral nerve block combined with general anesthesia on elderly patients undergoing knee replacement.Methods Two hundred elderly patients who underwent knee replacement in Luoyang Orthopedic Hospital of Henan Province from January 2016 to December 2020 were included retrospectively.According to the anesthesia methods,patients were divided into femoral nerve block combined with general anesthesia group and general anesthesia group,with 100 cases in each group.The pain degree,stress index and inflammatory factors at 24 hours after operation,and the incidence of postoperative adverse reactions were compared between the two groups.Results At 4 h,12 h,24 h and 48 h after operation,the visual analogue scale(VAS)scores of resting state and active state in the femoral nerve block combined with general anesthesia group were lower than those in the general anesthesia group(all P<0.05).At 24 h after operation,fasting blood glucose,serum cortisol,white blood cell count,C-reactive protein,interleukin-1β,and tumor necrosis factor-αlevels in the femoral nerve block combined with general anesthesia group were lower than those in the general anesthesia group(all P<0.05).The incidence of postoperative adverse reactions in the femoral nerve block combined with general anesthesia group(7.00%,7/100)was lower than that in the general anesthesia group(23.00%,23/100),P<0.05.Conclusions Femoral nerve block combined with general anesthesia has better a postoperative analgesia effect and a lower incidence of adverse reactions,which can effectively inhibit the stress reaction of the body,significantly reduce the release of inflammatory factors,and has higher safety.