股动脉联合股神经阻滞对膝关节镜下韧带重建术病人术中止血带反应及术后镇痛的影响

Effect of femoral nerve combined with femoral artery block on intraoperative tourniquet hypertension and postoperative analgesia in patients undergoing microscopic ligament reconstruction of the knee

目的探讨股动脉联合股神经阻滞对膝关节镜下韧带重建术病人术中止血带高血压及术后镇痛的影响。方法2022年1月~2022年12月膝关节镜下韧带重建术病人150例。应用随机数字表法将其分为3组,对照组(A组)、股神经阻滞组(B组)和股动脉联合股神经神经阻滞组(C组),每组各50例。A组未进行神经阻滞,B组给予0.2%罗哌卡因20 ml阻滞股神经,C组给予0.2%罗哌卡因10 ml股神经阻滞+10 ml股动脉阻滞。比较3组病人围术期生命体征、不同时间点乳酸值、艾司洛尔用量、止血带反应发生率、术后感觉阻滞时间、术后不同时间点VAS评分。结果A组、B组C组病人上止血带后60分钟收缩压分别为(140.14±5.46)mmHg、(136.02±4.55)mmHg和(131.02±9.26)mmHg;MAP分别为(90.26±4.45)mmHg、(84.62±4.28)mmHg和(79.18±3.53)mmHg;心率分别为(86.9±3.80)次/分、(76.18±3.19)次/分和(72.90±3.33)次/分;松止血带前1分钟收缩压分别为(150.06±5.69)mmHg、(145.20±4.83)mmHg和(136.66±9.04)mmHg,MAP(103.30±4.74)mmHg、(95.24±3.89)mmHg和(83.98±3.97)mmHg;心率分别为(92.44±5.79)次/分、(81.66±4.44)次/分和(74.26±4.93)次/分,差异有统计学意义(P<0.05)。3组病人松止血带5分钟乳酸值分别为(1.38±0.10)mmol/L、(1.35±0.09)mmol/L和(1.26±0.09)mmol/L;30分钟乳酸值分别为(1.48±0.08)mmol/L、(1.46±0.08)mmol/L和(1.29±0.07)mmol/L,各组比较差异有统计学意义(P<0.05)。3组病人术中艾司洛尔用量分别为(31.20±16.12)mg、(25.4±21.11)mg和(8.80±8.49)mg;止血带反应发生率分别为72%、64%和32%,差异有统计学意义(P<0.05)。3组术后1小时VAS评分分别为(2.72±0.73)分、(0.32±0.47)分和(0.30±0.46)分,6小时VAS评分分别为(5.40±0.61)分、(1.62±0.67)分和(1.66±0.63)分,12小时(4.28±0.78)分、(3.24±0.77)分和(3.36±0.60)分,24小时VAS评分分别为(3.16±0.68)分、(2.50±0.74)分(2.36±0.59)分,各时点比较差异均有统计学意义(P<0.05)。结论股动脉联合股神经阻滞可降低膝关节镜下韧带重建术病人术中止血带反应发生率,使术中循环更加稳定,降低乳酸值的快速增长,减少术后疼痛。

Objective To investigate the effect of femoral nerve combined with femoral artery block on intraoperative tourniquet response in patients with knee microscopic ligament reconstruction.Methods 150 patients with knee microscopic ligament reconstruction were selected.They were divided into three control groups(group A),femoral nerve block(Group B)and femoral nerve combined femoral artery nerve block(Group C),with 50 patients in each group.No nerve block was performed in group A,group B received 20 ml of 0.2% ropivacaine femoral nerve block and Group C received 0.2%ropivacaine 10 ml femoral nerve block+10 ml femoral artery block.Perioperative vital signs,lactate values at different time points,amount of esmolol,incidence of tourniquet reaction,postoperative sensory block time,and VAS scores at different postoperative time points were compared in the 3 groups.Results The systolic blood pressure of patients in group A,Group B and group C at 60 minutes after applying tourniquet was(140.14±5.46)mmHg,(136.02±4.55)mmHg and(131.02±9.26)mmHg,respectively,MAP values were(90.26±4.45)mmHg,(84.62±4.28)mmHg and(79.18±3.53)mmHg,respectively,the heart rate was(86.9±3.80)times/min,(76.18±3.19)times/min and(72.90±3.33)times/min,respectively.The systolic blood pressure at 1 minute before the tourniquet was(150.06±5.69)mmHg,(145.20±4.83)mmHg and(136.66±9.04)mmHg,respectively.MAP was(103.30±4.74)mmHg,(95.24±3.89)mmHg and(83.98±3.97)mmHg,respectively;Heart rate was(92.44±5.79)times/min,(81.66±4.44)times/min and(74.26±4.93)times/min,respectively;the difference was statistically significant(P<0.05).The 5minute lactic acid values of pine tourniquet were(1.38±0.10)mmol/L,(1.35±0.09)mmol/L and(1.26±0.09)mmol/L,respectively.The lactate values at 30min were(1.48±0.08)mmol/L,(1.46±0.08)mmol/L and(1.29±0.07)mmol/L,respectively,and there was statistical significance among all groups(P<0.05).The intraoperative dosage of esmolol in 3 groups were(31.20±16.12)mg,(25.4±21.11)mg and(8.80±8.49)mg,respectively.The incidence of tourniquet reaction was 72%,64% and 32%,respectively,with statistical significance(P<0.05).The VAS scores of the 3 groups were(2.72±0.73),(0.32±0.47)and(0.30±0.46)at 1 hour after operation,and(5.40±0.61),(1.62±0.67)and(1.66±0.63)at 6 hours,respectively.At 12 hours(4.28±0.78),(3.24±0.77)and(3.36±0.60),24hour VAS scores were(3.16±0.68)and(2.50±0.74),respectively.There was statistical significance at all time points(P<0.05).Conclusion The femoral nerve combined with femoral artery block can reduce the incidence of intraoperative tourniquet reaction in patients with knee endoscopic ligament reconstruction,make the intraoperative circulation more stable,reduce the rapid growth of lactic acid value,and reduce the postoperative pain.