彩色多普勒超声显像评估收肌管阻滞导管位置的效果

Color Doppler ultrasound imaging to evaluate the position of the adductor canal block catheter

目的 观察利用彩色多普勒超声显像快速、准确定位收肌管导管位置在全膝关节置换术(TKA)术后恢复中的应用。方法 选择初次进行全身麻醉下单侧TKA的患者60例,男26例,女34例,年龄50~80岁,BMI 18~30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:彩色多普勒超声显像组(CFD组)和水分离技术组(CUG组),每组30例。术后CFD组采用彩色多普勒超声显像确认导管位置,CUG组采用传统局麻药扩散的“水分离”技术判断导管位置。记录收肌管置管时间、置管期间使用局麻药总量,术后4、8、24、48、72 h静息和活动时VAS疼痛评分,镇痛泵总按压次数、补救镇痛情况、术后首次下床活动时间、术后住院时间,穿刺部位水肿、血肿、院内跌倒等术后不良事件发生情况和患者术后满意度评分。结果 与CUG组比较,CFD组置管时间明显缩短、置管期间使用局麻药总量明显减少(P<0.05),术后首次下床活动时间、术后住院时间明显缩短(P<0.05),术后穿刺部位水肿等不良事件发生率明显降低(P<0.05),患者术后满意度评分明显升高(P<0.05)。两组术后不同时点VAS疼痛评分、镇痛泵总按压次数和补救镇痛率、穿刺部位血肿和院内跌倒发生率差异均无统计学意义。结论 在TKA中应用彩色多普勒超声显像准确判断收肌管导管位置,能够实现快速准确放置导管,利于患者早期下床活动,缩短患者术后住院时间,提高患者满意度,促进早期康复。

Objective To observe the use of color Doppler ultrasound imaging to quickly and accurately locate the position of the adductor canal catheter during postoperative recovery after total knee arthroplasty(TKA).Methods Sixty patients,26 males and 34 females,aged 50-80 years,BMI 18-30 kg/m^(2),and ASA physical status Ⅰ-Ⅲ,who underwent primary TKA under general anesthesia were enrolled.Patients were divided into two groups by random number table method:the color Doppler ultrasound imaging group(group CFD) and the “water separation” technology group(group CUG),30 patients in each group.After surgery,patients in group CFD used color Doppler ultrasound imaging to confirm the catheter position,and the group CUG used the traditional “water separation” technology of local anesthetic diffusion to determine the catheter position.The adductor canal insertion time,total amount of local anesthetic used during insertion were recorded.VAS pain scores at rest and during activity at 4,8,24,48,and 72 hours after surgery were recorded.The total number of analgesic pump compressions,and rescue analgesia,time to the first ambulation after surgery,postoperative hospital stay were recorded.The puncture site edema,hematoma,in-hospital falls and patient postoperative satisfaction scores were recorded.Results Compared with group CUG,the adductor canal insertion time and the total amount of local anesthetic used during insertion were significantly decreased(P < 0.05),the time to the first ambulation after surgery and postoperative hospital stay were significantly decreased(P < 0.05),the incidence of puncture site edema were significantly decreased and the patient's postoperative satisfaction score were significantly increased in group CFD(P < 0.05).There were no significant differences in postoperative pain scores,total number of analgesic pump compressions,rescue analgesia rate,puncture site hematoma,and in-hospital fall rate between the two groups.Conclusion The use of color Doppler ultrasound imaging during TKA can accurately determine the position of the adductor canal catheter,allow for quick and accurate catheter placement,facilitate early patient ambulation,shorten the patient's postoperative hospital stay,while improving patient satisfaction,and promoting early recovery.