汤正美,李慧芹,胡一平
TANG Zhengmei,LI Huiqin,HU Yiping

• 1:联勤保障部队第904医院骨科
• 2:石家庄市第二医院

摘要(Abstract)：

目的 观察新型神经阻滞针对全膝关节置换术（TKA）老年患者行股神经连续阻滞（CFNB）的效果。方法 78例TKA老年患者随机分为常规组（常规神经阻滞针行CFNB）和试验组（新型神经阻滞针行CFNB），比较两组患者的穿刺次数、穿刺用时及起效时间，记录阻滞前、阻滞后（5、10、20以及30 min）血流动力学指标[心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO_2）]，于术后6、12、24、48、72 h记录两组患者的疼痛程度（VAS评分）及膝关节引流液中局部炎症反应指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]，观察术后12、24、48、72 h患肢股四头肌肌力、主动关节屈曲角度，记录住院期间血肿、感染、神经损伤、肌力障碍、渗漏率等并发症发生率。结果 试验组穿刺用时、穿刺次数少于常规组（P<0.05），试验组术后12 h静息及运动状态VAS得分、膝关节腔引流液中TNF-α、IL-6水平低于常规组（P<0.05）；试验组渗漏率低于常规组（P<0.05）。结论 新型神经阻滞针对TKA的老年患者行CFNB，可减少穿刺次数和并发症，缩短穿刺用时，减轻TKA患者疼痛程度及局部炎症反应。
Objective To explore the effect of novel nerve block needle on continuous femoral nerve block(CFNB) in elderly patients undergoing total knee arthroplasty(TKA).Methods A total of 78elderly patients who underwent TKA were randomly assigned to conventional group( CFNB using conventional nerve block needle) and experimental group(CFNB using novel nerve block needle).The puncture numbers, puncture time and onset time of CFNB action were compared between two groups. Hemodynamic indexes [ heart rate( HR), mean arterial pressure( MAP), blood oxygen saturation(SpO_2)] before and at 5, 10, 20, and 30 min after blockade were recorded. At 6, 12, 24,48, and 72 hours after TKA, the pain level( VAS score) of the patients and local inflammatory response indicators[tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)] in knee joint drainage fluid were measured. The quadriceps muscle strength and active joint flexion angle of the affected limb were observed at 12, 24, 48, and 72 hours after TKA. Complication incidences such as hematoma,infection, nerve injury, muscle dysfunction, leakage rate were recorded during hospitalization.Results Puncture time and frequency were less in experimental group than those in conventional group(P< 0. 05). VAS scores in the resting and exercise states and the levels of TNF-α and IL-6 in the drainage fluid of the knee joint cavity were lower in experimental group than those in conventional group at 12 hours after TKA(P< 0. 05). The leakage rate was less in experimental group than that in conventional group(P< 0. 05).Conclusion Performing CFNB using a novel nerve block needle in elderly patients undergoing TKA may reduce puncture numbers and the complications, shorten the puncture time, and reduce the pain and local inflammation.

关键词(KeyWords)： 股神经连续阻滞;新型神经阻滞针;老年人;全膝关节置换术;疼痛;并发症
continuous femoral nerve block (CFNB);novel nerve block needle;elderly;total knee arthroplasty (TKA);pain;complication

Abstract:

Keywords:

基金项目(Foundation): 石家庄市科学技术局（201461063）

作者(Author): 汤正美,李慧芹,胡一平
TANG Zhengmei,LI Huiqin,HU Yiping

DOI: 10.19367/j.cnki.2096-8388.2022.06.018

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