超声引导下股神经阻滞联合全身麻醉在膝关节置换术中的应用

Application of ultrasound-guided femoral nerve block combined with general anesthesia in knee replacement surgery

目的 探讨超声引导下股神经阻滞联合全身麻醉在膝关节置换术中的临床应用价值。方法 选取2022年5月~2023年5月在潍坊市中医院行全膝关节置换术的患者120例,随机分为实验组和对照组,每组60例。实施全身麻醉后,实验组在超声引导下行罗哌卡因股神经阻滞,对照组给予生理盐水注射。比较两组患者麻醉前(T1)、上驱血带时(T2)、切皮时(T3)、手术结束时(T4)共4个时间点的平均动脉压(MAP)和心率变化,苏醒后0.5h、1h和6h视觉模拟(VAS)评分,以及术后6h内不良反应发生情况。结果 两组患者T1时的MAP和心率无明显差异(P>0.05),T2、T3、T4时实验组MAP和心率均低于对照组(P<0.05);苏醒后各个时间点VAS评分实验组均低于对照组(P<0.05);实验组术后6h内不良反应发生率均低于对照组(P<0.05)。结论 超声引导下股神经阻滞具有稳定患者术中血流动力学,降低应激反应,减轻术后疼痛,减少不良反应等优势,值得临床推广。

Objective To explore the clinical application value of ultrasound-guided femoral nerve block combined with general anesthesia in knee replacement surgery.Methods One hundred and twenty patients who under-went total knee arthroplasty in our hospital from May 2022 to May 2023 were selected and randomly divided into an ex-perimental group and a control group,with 60 patients in each group.Both groups of patients were treated with general anesthesia.The experimental group received ropivacaine femoral nerve block under ultrasound guidance,while the control group received the same saline injection.Record the average arterial pressure(MAP)and heart rate changes at various time points before anesthesia(T1),during upper bloodline displacement(T2),during skin incision(T3),and at the end of surgery(T4)for two groups of patients;Record visual analogue(VAS)scores at 0.5,1,and 6 hours after awakening;Record adverse reactions such as nausea,vomiting,chills,and abdominal distension within 6 hours after surgery.Results There was no significant difference in MAP and heart rate between the two groups of patients at T1(P>0.05),while there was a statistical difference in MAP and heart rate at T2,T3,and T4(P<0.05);There was a statistically significant difference in VAS scores at various time points after awakening(P<0.05);The adverse reactions of nausea,vomiting,chills,and abdominal distension within 6 hours after surgery in both groups of patients were statistically significant(P<0.05).Conclusion n Ultrasound guided femoral nerve block has the advantages of making intraoperative hemodynamics more stable,reducing stress reactions,reducing postoperative pain,and relatively fewer adverse reactions in patients.