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| 超声引导下腹股沟韧带上髂筋膜阻滞对膝关节镜下交叉韧带重建术患者止血带相关反应的影响 |
| Effect of ultrasound-guided supra-inguinal fascia iliaca block on tourniquet-associated reactions during arthroscopic cruciate ligament reconstruction |
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| DOI：10.12089/jca.2023.06.001 |
| 中文关键词: 超声 腹股沟韧带上髂筋膜阻滞 膝关节镜下交叉韧带重建术 止血带 缺血-再灌注损伤 |
| 英文关键词: Ultrasound Supra-inguinal iliaca fascia block Arthroscopic cruciate ligament reconstruction Tourniquet Ischemia-reperfusion injury |
| 基金项目:中央军委后勤面上项目（CLB19J051）；解放军西部战区总医院院管课题（2021-XZYG-A10） |
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| 中文摘要: |
目的 探讨超声引导下腹股沟韧带上髂筋膜阻滞对全麻下行膝关节镜下交叉韧带重建术（ACLR）患者术中止血带相关反应以及缺血-再灌注损伤的影响。
方法 选择行膝关节镜下交叉韧带重建术患者86例，男58例，女28例，年龄18～64岁，BMI 17～28 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：超声引导下腹股沟韧带上髂筋膜阻滞联合全麻组（B组）和单纯全麻组（C组），每组43例。B组于超声引导下行腹股沟韧带上髂筋膜阻滞联合全麻，C组仅行全麻，术毕均行静脉自控镇痛。记录麻醉诱导时（T0）、止血带充气即刻（T1）、止血带充气后60 min（T2）、止血带充气后90 min（T3）、放松止血带即刻（T4）、放松止血带后10 min（T5）的HR和MAP，于T1、T5时抽取静脉血测定血清丙二醛（MDA）和乳酸（Lac）浓度。记录入PACU即刻（T6）、术后6 h（T7）、12 h（T8）、24 h（T9）静息和活动时VAS疼痛评分。记录术中丙泊酚和瑞芬太尼总用量、术后镇痛泵总按压次数、镇痛泵有效按压次数和氟比洛氛酯补救镇痛例数。记录术后神经损伤、寒颤、术后恶心呕吐等不良反应的发生情况。
结果 与T1时比较，T5时两组血清MDA和Lac浓度明显升高（P<0.05）。与C组比较，T2—T5时B组HR明显减慢，MAP明显降低（P<0.05），T5时B组MDA和Lac浓度明显降低（P<0.05），T6、T7时B组静息和活动时VAS疼痛评分明显降低（P<0.05），B组术中丙泊酚和瑞芬太尼总用总量明显减少（P<0.05），B组术后镇痛泵总按压次数、有效按压次数明显减少、氟比洛氛酯补救镇痛率明显降低（P<0.05）。T8、T9时两组静息和活动时VAS疼痛评分、术后神经损伤、寒颤、术后恶心呕吐等不良反应发生率差异无统计学意义。
结论 腹股沟韧带上髂筋膜阻滞可减轻止血带相关反应，减轻肢体缺血-再灌注后脂质过氧化反应，减少MDA及Lac等生成，从而减轻缺血-再灌注损伤。 |
| 英文摘要: |
Objective To observe the effect of ultrasound-guided supra-inguinal iliaca fascia block on tourniquet-associated reactions and ischemia-reperfusion injury during arthroscopic cruciate ligament reconstruction (ACLR).
Methods Eighty-six patients scheduled for ACLR, 58 males and 28 females, aged 18-64 years, BMI 17-28 kg/m2, ASA physical status Ⅰ or Ⅱ, were enrolled and randomly assigned into two groups: SIFIB combined general anesthesia group (group B) and general anesthesia group (group C), 43 patients in each group. Patients in group B underwent ultrasound-guided SIFIB, both groups were induced by routine general anesthesia method, and patient-controlled intravenous analgesia (PCIA) was given after the operation. HR and MAP were recorded at general anesthesia induction (T0), tourniquet inflation (T1), 60 minutes after inflation (T2), 90 minutes after inflation (T3), tourniquet deflation (T4), and 10 minutes after the tourniquet deflation (T5). The level of malondialdehyde (MDA) and lactic acid (Lac) were detected at T1 and T5. The VAS pain score at rest and during exercise were evaluated when the patients were in PACU (T6), 6 (T7), 12 (T8), and 24 hours (T9) after the operation. The dosage of remifentanil, propofol, actual pressing times, effective pressing times and the rescue cases of flurbiprofen axetil were recorded. The incidence of postoperative nerve injury, shivering, postoperative nausea and vomiting and other adverse reactions were recorded.
Results Compared with group C, HR and MAP in group B were significantly lower at T2-T5 (P < 0.05). Compared with T1, MDA and Lac were significantly increased at T5 in both two groups (P < 0.05). Compared with group C, the levels of MDA and Lac were lower in group B at T5 (P < 0.05), VAS pain scores at rest and during exercise were significantly higher in group C at T6 and T7 (P < 0.05). Compared with group C, the total use of propofol and remifentanil in group B was significantly reduced (P < 0.05), the total number and effective number of postoperative analgesic pump in group B were significantly reduced, and the relief analgesic rate of flurbilofen was significantly decreased (P < 0.05). There was no significant difference in VAS pain scores at rest and during exercise between the two groups at T8 and T9. There were no significant differences in the incidence of postoperative nerve injury, shivering, postoperative nausea and vomiting and other adverse reactions between the two groups.
Conclusion SIFIB can alleviate the tourniquet-associated recation, inhibit lipid peroxidation reaction, reduce the levels of MDA and Lac, and reduce ischemia-reperfusion injury during ACLR. |
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