超声引导下不同浓度罗哌卡因股神经阻滞对膝关节置换术患者血流动力学及认知功能、关节功能的影响

Effects of different concentrations of ropivacaine femoral nerve block under ultrasound guidance on hemodynamics,cognitive function,and joint function in patients undergoing knee arthroplasty

目的探讨超声引导下不同浓度罗哌卡因股神经阻滞对膝关节置换术患者血流动力学、认知功能、关节功能的影响。方法回顾性分析2022年1月至2023年12月在佛山市中医院行膝关节置换术的110例患者的临床资料,根据超声引导下股神经阻滞罗哌卡因浓度的不同,将患者分为甲组(0.35%罗哌卡因)37例、乙组(0.375%罗哌卡因)37例和丙组(0.4%罗哌卡因)36例。麻醉前、插管时、拔管时及拔管后5min,比较三组患者的血流动力学[收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO_(2))]情况;于术前、术后1 d、3 d,采用简易智力状况检查法(MMSE)评估三组患者的认知功能;术后4h、12h、24h,评估三组患者的关节功能(患肢主动膝关节屈曲角度、肌力评分)情况;同时比较三组患者的不良反应情况。结果插管时、拔管时,三组患者的SBP、DBP、心率、SpO_(2)均升高,但乙组患者的SBP、DBP、心率、SpO_(2)水平均低于甲组和丙组,且甲组低于丙组,而拔管后5 min,三组患者的SBP、DBP、心率、SpO_(2)均下降,且乙组低于甲组和丙组,甲组低于丙组,差异均有统计学意义(P<0.05);术后4h、12h、24h,乙组患者的关节主动屈曲角度、肌力均高于甲组和丙组,且甲组高于丙组,差异均有统计学意义(P<0.05);术后1d,三组患者的MMSE评分均降低,但乙组的MMES评分高于甲组和丙组,且甲组高于丙组,差异均有统计学意义(P<0.05);三组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论超声引导下0.375%的罗哌卡因股神经阻滞可维持膝关节置换术患者血流动力学稳定,促进患者术后早期关节功能恢复及认知功能恢复,安全有效,可在临床推广应用。

Objective To explore the effects of different concentrations of ropivacaine femoral nerve block un-der ultrasound guidance on hemodynamics,cognitive function,and joint function in patients undergoing knee arthroplas-ty.Methods The clinical data of 110 patients who underwent knee arthroplasty in Foshan Hospital of Traditional Chi-nese Medicine from January 2022 to December 2023 were retrospectively analyzed.According to the different concentra-tions of ropivacaine in femoral nerve block under ultrasound,the patients were divided into three groups:group A(0.35%ropivacaine)with 37 cases,group B(0.375%ropivacaine)with 37 cases,and group C(0.4%ropivacaine)with 36 cases.The hemodynamics[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and blood oxygen saturation(SpO_(2))]before anesthesia,during intubation,during extubation,and 5 minutes after extubation were compared among the three groups.The cognitive function among the three groups was evaluated using the Mini-mental State Examination(MMSE)before and at 1 day and 3 days after surgery.The joint function(active knee flexion angle and muscle strength score)at 4 h,12 h,and 24 h after surgery were evaluated among the three groups.The adverse reac-tions of three groups simultaneously were compared.Results During intubation and extubation,the levels of SBP,DBP,heart rate,and SpO_(2)in all three groups increased,and the levels were significantly lower in group B than group A and group C,and also in group A than group C;however,at 5 minutes after extubation,the levels in all three groups de-creased,which were significantly lower in group B than group A and group C,and also in group A than group C,with sta-tistically significant differences(P<0.05).At 4 hours,12 hours,and 24 hours after surgery,the joint active flexion angle and muscle strength in group B were significantly higher than those of the group A and group C,and they were also sig-nificantly higher in group A than group C,with statistically significant differences(P<0.05).One day after operation,the MMSE scores of all three groups decreased,and the MMES scores in group B were significantly higher than those of group A and group C,and also significantly higher in group A than group C,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Ultrasound-guided 0.375%ropivacaine femoral nerve block can maintain hemodynamic stability in patients undergoing knee arthroplasty,promote early postoperative recovery of joint function and cognitive function,and is safe and effective,which should be widely applied in clinical practice.