摘要
目的分析超声定位下神经阻滞麻醉结合浸润麻醉用于行全膝关节置换术(TKA)术的膝关节骨性关节炎(KOA)患者中的临床效果。方法前瞻性将2017年1月至2018年12月间中国人民解放军联勤保障部队第909医院收治的80例行TKA治疗的KOA患者随机分为观察组及对照组,各40例。对照组行常规麻醉方案干预,观察组采用超声定位下神经阻滞麻醉结合浸润麻醉干预。手术后6 h、12 h、24 h及48 h时检测患者机械痛阈值及视觉模拟评分(VAS)量表评分;记录两组患者恢复清醒、监护室停留、自主呼吸恢复及出室时间;麻醉前及麻醉后12 h时检测患者血清中丙二醛(MDA)、晚期蛋白氧化产物(AOPP)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)水平;治疗前、术后1个月及术后2个月时采用Lysholm评分量表评估患者髋关节功能恢复情况,并记录患者尿潴留、恶心、呕吐、低氧血症等不良反应发生情况。结果术后6 h、术后12 h、术后24 h及术后48 h时观察组机械痛阈值明显高于对照组,差异有统计学意义(P<0.05);观察组自主呼吸恢复、监护室停留、恢复清醒及出室时间均明显低于对照组,差异有统计学意义(P<0.05);术后6 h、术后12 h、术后24 h及术后48 h时观察组VAS评分明显低于对照组,差异均统计学意义(P<0.05);治疗后观察组血中MDA及AOPP水平低于对照组,GSH-PX及SOD水平高于对照组,差异均有统计学意义(P<0.05);观察组治疗后2个月及4个月Lysholm水平高于对照组,差异有统计学意义(P<0.05);观察组术后尿潴留、恶心、呕吐及低氧血症发生率均明显低于对照组,差异有统计学意义(P<0.05)。结论KOA患者采用TKA术治疗时行超声定位下神经阻滞麻醉结合浸润麻醉可显著提高患者镇痛效果,提高临床疗效,改善体内氧化应激反应,降低患者不良反应发生率。
Objective Analyze the clinical effect of neurostimulation under the positioning of nerve block anesthesia combined with invasive anesthesia for knee osteoarthritis(KOA)patients undergoing TKA.Methods Eighty patients with KOA who underwent TKA treatment from January 2017 to December 2018 were randomly divided into observation group and control group;the control group underwent routine anesthesia intervention,and the observation group performed neurostimulator positioning of nerve block anesthesia combined with infiltration anesthesia.The mechanical pain threshold and VAS scale score were detected at 6 h,12 h,24 h and 48 h after operation;The recovery time,spontaneous breathing recovery time,intensive care unit stay time and exit time of the two groups were recorded;The levels of MDA,AOP,SOD and GSH-PX in the serum were measured before anesthesia and 12 h after anesthesia.The recovery of hip function was evaluated by Lysholm scale before,1 month and 2 months after treatment.The patients’urinary retention,nausea,vomiting,hypoxemia and other adverse reactions were recorded.Results The mechanical pain threshold of the observation group was significantly higher than that of the control group at 6 h,12 h,24 h and 48 h after operation,and the difference was statistically significant(P<0.05).The spontaneous breathing recovery time,recovery awake time,the staying and outpatient time of the intensive care unit in observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores of the observation group 6 h,12 h,24 h and 48 h after surgery were significantly lower than those in the control group,and the difference were statistically significant(P<0.05).The levels of MDA and AAOPPS in the observation group were significantly lower than those in the control group,and the levels of GSH-PX and SOD were significantly higher than those in the control group(P<0.05).The level of Lysholm in the observation group was significantly higher than that in the control group at 2 months and 4 months after treatment,and the difference was statistically significant(P<0.05).The postoperative urinary retention,nausea and the incidence of vomiting and hypoxemia in observation group were significantly lower than that of the control group,and the differences were statistically significant(P<0.05).Conclusion In patients with KOA who underwent TKA,neuromuscular anesthesia combined with invasive anesthesia can significantly improve the analgesic effect of patients and improve the clinical efficacy and the oxidative stress response in vivo to reduce the incidence of adverse reactions in patients.
作者
陈建华
刘建东
张镇城
CHEN Jian-hua;LIU Jian-dong;ZHANG Zhen-cheng(Department of Anesthesiology,909 Hospital of the Chinese People's Liberation Army,Zhangzhou Fujian 350600,China)
出处
《临床和实验医学杂志》
2020年第5期556-559,共4页
Journal of Clinical and Experimental Medicine
基金
福建省自然科学基金项目(编号:2016J01575).
作者简介
通讯作者:张镇城,E-mail:dincia@163.com
