坐骨神经联合股神经阻滞下全膝关节置换术病人不同浓度罗哌卡因应用效果比较

doi:10.3969/j.issn.1005-6483.2020.09.031

摘要/Abstract

摘要： 目的探讨不同浓度罗哌卡因坐骨神经联合股神经阻滞麻醉对全膝关节置换术(TKA)病人镇痛效果及股四头肌肌力恢复的影响。
方法 2018年4月～2019年11月接受TKA病人95例，采用随机数字表法分为A组(31例)、B组(32例)和C组(32例)。3组均给予0.4%罗哌卡因20ml股神经阻滞，A组给予0.35%罗哌卡因20ml坐骨神经阻滞，B组给予0.375%罗哌卡因20ml坐骨神经阻滞，C组给予0.4%罗哌卡因20ml坐骨神经阻滞。比较不同时间点静息疼痛评分(RVAS)、活动疼痛评分(IVAS)、股四头肌肌力以及麻醉所致不良反应。
结果术后6小时、12小时、24小时、36小时，A组RVAS评分高于B组、C组，B组RVAS评分高于C组(P<0.05)。术后24小时、36小时，A组IVAS评分高于B组、C组，B组IVAS评分高于C组(P<0.05)。术后6小时、12小时、24小时、36小时，A组肌力高于B组、C组，B组肌力高于C组(P<0.05)。A组、B组、C组股四头肌肌力恢复时间比较分别为(8.65±1.12)小时、(20.12±2.24)小时和(24.36±2.56)小时，差异有统计学意义(P<0.05)。A组、B组、C组麻醉所致不良反应分别为35.48%、31.25%和37.50%，差异无统计学意义(P>0.05)。
结论 0.375%罗哌卡因坐骨神经联合股神经阻滞麻醉能保证满意的镇痛效果，有利于TAK病人术后肌力恢复。

关键词: 全膝关节置换术, 神经阻滞, 罗哌卡因, 镇痛, 肌力

Abstract: Objective To study effects of analgesic effect and muscle strength recovery of different concentrations of ropivacaine sciatic nerve combined with femoral nerve block for patients with total knee arthroplasty(TKA).
Methods 95 patients with TKA from April 2018 to November 2019 were divided into Group A(31 cases),Group B(32 cases) and Group C(32 cases).All patients given 20 ml 0.4% ropivacaine femoral nerve block,Group A given 20 ml 0.35% ropivacaine sciatic nerve block,Group B given 20 ml 0.37% ropivacaine sciatic nerve block,Group C given 20 ml 0.4% ropivacaine sciatic nerve block.Then RVAS,IVAS,quadriceps femoris muscle strength,anaesthesia induced adverse reactions were compared between three groups.
Result 6h,12h,24h,36h after operation,RVAS of Group A was higher than that of Group B and Group C,RVAS of Group B was higher than that Group C(P<0.05).24h,36h after operation,IVAS of Group A was higher than that Group B and Group C,IVAS of Group B was higher than that Group C(P<0.05).h,12h,24h,36h after operation,muscle strength score of Group A was higher than that Group B and Group C,muscle strength score of Group B was higher than that Group C(P<0.05).There were significant difference in the recovery time of quadriceps femoris between Group A,Group B and Group C[(8.65±1.12)h vs (20.12±2.24)h vs (24.36±2.56)h](P<0.05).There were no significant difference in adverse reactions between Group A,Group B and Group C(35.48% vs 31.25% vs 37.50%)(P>0.05).
Conclusion 0.375% ropivacaine sciatic nerve combined with femoral nerve block anesthesia can ensure satisfactory analgesic effect,which is conducive to the recovery of muscle strength in patients with TAK.

Key words: total knee arthroplasty, nerve block, ropivacaine, analgesia, muscle strength

胡峰李菊王伟. 坐骨神经联合股神经阻滞下全膝关节置换术病人不同浓度罗哌卡因应用效果比较[J]. 临床外科杂志, 2020, 28(9): 893-896.

HU Feng, LI Ju, WANG Wei.. Comparison of effects of different concentrations of ropivacaine in total knee arthroplasty patients with sciatic nerve combined with femoral nerve block[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(9): 893-896.

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