超声引导下连续股神经阻滞对全膝关节置换术后镇痛和夜间睡眠质量及快速康复的影响

Effects of continuous femoral nerve block under ultrasound guidance on analgesia,nocturnal sleep quality and rapid recovery after total knee arthroplasty

目的探讨超声引导下连续股神经阻滞(UGCFNB)对全膝关节置换术(TKA)后镇痛和夜间睡眠质量及快速康复的影响。方法选择2019年5月至2021年6月于四川省骨科医院开展TKA的患者90例,其中男性40例,女性50例;年龄44~77岁,平均年龄60.51岁;身体质量指数(BMI)为22.35~24.65 kg/m^(2),平均BMI 23.51 kg/m^(2)。以随机抽签法分为2组,每组45例。对照组和观察组分别采用硬膜外镇痛和UGCFNB。比较术后4、8、12、24 h静息状态下和被动运动状态下的镇痛效果,测量两组术后各个时间点患肢主动关节屈曲角度情况并对两组股四头肌肌力进行比较,评估两组术后的睡眠质量和不良反应发生率。结果观察组术后4、8、12、24、48 h静息状态下[分(3.43±0.51)vs(3.71±0.55)分、(3.06±0.45)分vs(3.23±0.48)分、(1.15±0.17)分vs(2.97±0.44)分、(1.07±0.16)分vs(2.44±0.36)分、(0.87±0.13)分vs(1.71±0.25)分]和术后24、48 h被动运动状态下的疼痛视觉模拟量表(VAS)评分均明显低于对照组[(4.41±0.66)分vs(6.34±0.95)分、(4.85±0.57)分vs(6.76±1.01)分。P<0.05]。术后24、48 h两组患肢主动关节屈曲角度较术前12 h明显提高,且与对照组相比较,观察组患肢主动关节屈曲角度明显较大[(46.36±6.95)°vs(32.93±4.93)°、(66.41±9.96)°vs(47.52±7.12)°。P<0.05];两组睡眠质量较术前相比较均有所提高,且观察组术后6 h、24 h、48 h的匹茨堡睡眠质量指数(PSQI)评分均明显低于对照组[(4.43±0.66)分vs(6.54±0.98)分、(2.07±0.31)分vs(4.63±0.69)分,(1.84±0.27)分vs(3.95±0.59)分。P<0.05];观察组不良反应发生率为6.66%(3/45),明显低于对照组22.22%(10/45)(P<0.05)。结论UGCFNB对TKA术后患者能起到良好的镇痛效果,有利于促进肢体运动功能的康复,且不会对股四头肌肌力造成影响,同时也能改善患者睡眠质量,降低不良反应发生率。

Objective To investigate the effect of ultrasound-guided continuous femoral nerve block(UGCFNB)on postoperative analgesia,nocturnal sleep quality and rapid recovery after total knee arthroplasty(TKA).Methods From May 2019 to June 2021,a total of 90 patients performed TKA were enrolled,which included 40 males and 50 females,aged 44-77 years old with mean age of 60.51 years old;body mass index(BMI)was 22.35-24.65 kg/m^(2) with mean BMI of 23.51 kg/m^(2).All of them were randomly divided into control group(n=45,treated with epidural analgesia)and observation group(n=45,performed UGCFNB),respectively.The analgesic effects in resting state and passive motion state at 4-,8-,12-and 24-hour after operation of 2 groups were compared.The active joint flexion angle of affected limb at each time point after operation was measured and quadriceps muscle strength between 2 groups were compared.The sleep quality and incidence of adverse reactions in 2 groups were evaluated.Results The visual analogue scale(VAS)scores of observation group at 4-,8-,12-,24-and 48-hour after operation in resting state[(3.43±0.51)scores vs(3.71±0.55)scores,(3.06±0.45)scores vs(3.23±0.48)scores,(1.15±0.17)scores vs(2.97±0.44)scores,(1.07±0.16)scores vs(2.44±0.36)scores,(0.87±0.13)scores vs(1.71±0.25)scores]and passive motion state at 24-and 48-hour after operation were statistically significantly lower than those of control group[(4.41±0.66)scores vs(6.34±0.95)scores,(4.85±0.57)scores vs(6.76±1.01)scores.P<0.05].The active joint flexion angle of 2 groups at 24-and 48-hour after operation was significantly higher than that at 12-hour before operation,and the active joint flexion angle of observation group was significantly larger than that of control group[(46.36±6.95)°vs(32.93±4.93)°,(66.41±9.96)°vs(47.52±7.12)°,P<0.05].After treatment,the sleep quality of 2 groups was improved compared with that before operation,and Pittsburgh sleep quality index(PSQI)scores at 6-,24-and 48-hour after operation of observation group were significantly lower than those of control group[(4.43±0.66)scores vs(6.54±0.98)scores,(2.07±0.31)scores vs(4.63±0.69)scores,(1.84±0.27)scores vs(3.95±0.59)scores.P<0.05].The incidence of adverse reactions in observation group[6.66%(3/45)]was significantly lower than that in control group[22.22%(10/45)](P<0.05).Conclusion It is demonstrated that UGCFNB could play an analgesic effect of satisfactoriness on patients after TKA,which is conducive to promote rehabilitation of limb motor function,with unaffected muscle strength of quadriceps femoris.Meantime,it also improves the sleep quality of patients and reduces the incidence of adverse reactions.