超声引导下连续股神经阻滞对老年膝关节置换术后血流动力学及血液流变学的影响

目的分析超声引导下连续股神经阻滞对老年膝关节置换术后患者的血流动力学及血液流变学影响,探讨股神经阻滞的镇痛价值。方法选取我院接受膝关节置换术治疗的79例老年患者为研究对象,根据随机数字表法分为对照组40例和研究组39例。对照组术后采用传统静脉自控持续镇痛,研究组采用超声引导下连续股神经阻滞,分别于术后4、8、12、24 h静息状态和48、72 h被动运动状态,采用视觉模拟评分(VAS)评价镇痛效果;分别于镇痛装置连接时、连接后12 h和48 h(T0、T1、T2)检测并记录患者血流动力学指标及血液流变学指标;记录两组镇痛期间不良反应发生率。比较两组上述参数的差异。结果研究组术后各时点静息状态下和被动运动状态下VAS评分均低于对照组,差异均有统计学意义(均P<0.05)。两组术后T0、T1、T2时点血氧饱和度和平均动脉压水平比较,差异均无统计学意义;两组T0时点心率比较差异无统计学意义,T1、T2时点的心率均较T0时点升高,研究组升高幅度低于对照组,差异有统计学意义(P<0.05)。两组T0时点各血液流变学指标比较差异无统计学意义;对照组在T1、T2时点的血浆粘度、全血高切粘度、全血低切粘度均高于研究组,差异均有统计学意义(均P<0.05)。镇痛期间恶心、呕吐发生率低于对照组。结论超声引导下连续股神经阻滞对老年膝关节置换术后镇痛效果好,患者血流动力学稳定,血液流变学所受影响小,对促进术后康复有重要价值。

Effect of ultrasound-guided continuous femoral nerve block on postoperative hemodynamics and hemorheology of senile total knee arthroplasty

Objective To analyze the feasibility and safety of ultrasound-guided continuous femoral nerve block in senile total knee arthroplasty (TKA), and to provide reference for postoperative analgesia of lower limb surgery. Methods 79 senile patients with unilateral TKA in the hospital from August 2016 to November 2018 were selected, and they were divided into control group (40 cases) and research group (39 cases) by random number table. Control group was given postoperative patient-controlled intravenous analgesia, while research group was given ultrasound-guided continuous femoral nerve block. The incidence of adverse reactions during analgesia was recorded. The analgesic effects were evaluated by postoperative visual analogue scale (VAS) on postoperative 4h, 8h, 12h and 24h rest state, 48h and 72h passive motion state. At the time of connection of analgesia device (T0), after connection for 12h (T1) and after connection for 48h (T2), the hemodynamics indexes [heart rate (HR), oxygen saturation (SpO2), mean arterial pressure (MAP)] and hemorheology indexes were detected and recorded. Results The pressing number of patient-controlled analgesia in research group was less than that in control group, the incidence of nausea and vomiting in research group during analgesia was lower than that in control group (P<0.05); At each time after surgery under rest sate or passive motion state, the VAS scores of research group were lower than those of control group (P<0.05); At each time after surgery, there was no statistical difference in the levels of MAP and SpO2 between the two groups (P>0.05); There was no statistical difference in the HR between the two groups at T0 (P>0.05), the levels of HR in the two groups at T1 and T2 were higher than those at T0, but the increased range of research group was lower than that of control group (P<0.05); There was no statistical difference in the levels of hemorheology indexes between the two groups at T0 (P>0.05); The plasma viscosity, whole blood high-shear viscosity and whole blood low-shear viscosity in control group at T1 and T2 were higher than those in research group (P<0.05). Conclusion Ultrasound-guided continuous femoral nerve block in senile TKA has better analgesic effects, it can stabilize hemodynamics, have less effect on hemorheology, achieve less adverse reactions, enhance surgical effects and promote postoperative rehabilitation.