文章摘要
收肌管阻滞与股神经阻滞对老年患者全膝关节置换术后恢复质量影响的比较
Comparison of the influences of adductor canal block and femoral nerve block on the quality of recovery after total knee arthroplasty in elderly patients
  
DOI：10.12089/jca.2025.05.004
中文关键词: 收肌管阻滞  股神经阻滞  恢复质量  全膝关节置换术  老年
英文关键词: Adductor canal block  Femoral nerve block  Quality of recovery  Total knee arthroplasty  Aged
基金项目:河北省重点研发计划（21377782D）；河北省医学适用技术跟踪项目（GZ2024053）；河北省医学科学研究课题计划（20221203,20221210）
作者单位E-mail
郭立发 050051,石家庄市,河北医科大学第三医院麻醉二科  
胡芳 050051,石家庄市,河北医科大学第三医院手术室  
李金茹 050051,石家庄市,河北医科大学第三医院麻醉二科  
刘兰兰 050051,石家庄市,河北医科大学第三医院麻醉二科  
杨淑红 050051,石家庄市,河北医科大学第三医院手术室  
刘欣 050051,石家庄市,河北医科大学第三医院麻醉二科  
赵爽 050051,石家庄市,河北医科大学第三医院麻醉二科  
王秀丽 050051,石家庄市,河北医科大学第三医院麻醉二科  
李昭 050051,石家庄市,河北医科大学第三医院麻醉二科 lixiaozhao1989@163.com 
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中文摘要:
      
目的：观察和比较收肌管阻滞与股神经阻滞对全麻下老年患者全膝关节置换术（TKA）后恢复质量的影响。
方法：选择2023年5—12月行单侧TKA患者100例，男24例，女76例，年龄65～80岁，BMI 18.5～35.0 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：收肌管神经阻滞组（A组）与股神经阻滞组（F组），每组50例。术前30 min A组于收肌管注射0.375%罗哌卡因10 ml行收肌管神经阻滞，F组于腹股沟注射0.375%罗哌卡因10 ml行股神经阻滞。术后24、48 h记录QoR-15量表并采用徒手肌力法（MMT）评估手术侧下肢肌力情况，记录术后自主呼吸恢复时间、拔管时间、首次下床活动时间、术后48 h静脉血C-反应蛋白（CRP）浓度、术后24、48 h静息、活动时NRS疼痛评分、术后24 h内患者镇痛满意度、镇痛泵有效按压次数、镇痛泵总按压次数、补救镇痛情况、反弹性疼痛发生情况、不良反应发生情况。
结果：与F组比较，A组术后48 h QoR-15评分和术后24 h MMT评分明显升高，首次下床活动时间明显缩短，术后48 h CRP浓度明显降低（P＜0.05）。两组术后自主呼吸恢复时间、拔管时间、术后24 h QoR-15评分、24、48 h MMT评分和NRS疼痛评分、镇痛满意率、镇痛泵有效按压次数、镇痛泵总按压次数、补救镇痛率差异均无统计学意义。两组反弹性疼痛、术后24 h内恶心呕吐、心律失常、头晕发生率差异均无统计学意义。
结论：与股神经阻滞比较，收肌管阻滞更好地保留老年患者TKA手术侧下肢肌力，缩短术后首次下床活动时间，提高患者术后恢复质量。
英文摘要:
      
Objective: To compare the effects of general anesthesia combined with nerve blocks on postoperative quality of recovery in elderly patients after total knee arthroplasty (TKA).
Methods: A total of 100 patients, aged 65-80 years, 24 males and 76 females, BMI 18.5-35.0 kg/m2, ASA physical status Ⅱ or Ⅲ, underwent unilateral TKA from May 2023 to December 2023 were selected. Patients were divided into two groups by random number table method: adductor nerve block group (group A) and femoral nerve block group (group F), 50 patients in each group. Group A was injected 0.375% ropivacaine 10 ml in the adductor canal block, and group F was injected 0.375% ropivacaine 10 ml in the groin for femoral nerve block 30 minutes before operation. Record the QoR-15 scale, and the muscle strength of the lower limb on the operated side was evaluated by manual muscle strength (MMT) 24 and 48 hours after surgery. Record the recovery time of spontaneous breathing, the time of extubation, and the time of first descent, the level of C-reactive protein (CRP) in venous blood 48 hours after surgery, the NRS pain scores at rest and during exercise 24 and 48 hours after surgery, the satisfaction with analgesia within 24 hours after surgery, the number of effective compressions and total compressions of analgesic pump, the remedial analgesia, occurrence of rebound pain, and occurrence of adverse reactions.
Results: Compared with group F, QoR-15 scores 48 hours after surgery and MMT scores 24 hours after surgery were significantly increased, the time of first landing was significantly shortened, the level of CRP 48 hours after surgery was significantly decreased (P < 0.05). There were no significantly differences in postoperative spontaneous breathing recovery time, extubation time, QoR-15 score 24 hours after surgery, MMT scores and NRS pain scores 24 and 48 hours after surgery, the rate of analgesia satisfaction, the effective number of analgesia pump presses, the total number of analgesia pump presses, and the rate of salvage analgesia between the two groups. There were no significantly differences in the incidence of rebound pain, nausea and vomiting, arrhythmia, and dizziness within 24 hours after surgery between the two groups.
Conclusion: Compared with femoral nerve block, adductor canal block can better preserve the muscle strength of the lower limb on the operated side of the patient, shorten the time of the first postoperative descent, and improve the quality of the patient's postoperative recovery after TKA.
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