收肌管阻滞联合全麻对老年全膝关节置换术患者术后疼痛和认知功能的影响

doi:10.11958/20231230

天津医药 ›› 2024, Vol. 52 ›› Issue (5): 523-527.doi: 10.11958/20231230

收肌管阻滞联合全麻对老年全膝关节置换术患者术后疼痛和认知功能的影响

韩正怡(), 李锐, 陈齐, 王家友, 盛奎, 宋洁, 张野^△()

安徽医科大学第二附属医院麻醉与围手术期医学科（邮编230601）

收稿日期:2023-08-14 修回日期:2023-10-24 出版日期:2024-05-15 发布日期:2024-05-09
通讯作者: ^△ E-mail：zhangye_hassan@sina.com
作者简介:韩正怡（1991），女，主治医师，主要从事老年骨科麻醉方面研究。E-mail：hzy_anyi@126.com
基金资助:
湖北陈孝平科技发展基金会资助项目(CXPJJH12000005-07-119);安徽省重点研究与开发计划项目(201904a07020065)

Effects of ultrasound-guided adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty

HAN Zhengyi(), LI Rui, CHEN Qi, WANG Jiayou, SHENG Kui, SONG Jie, ZHANG Ye^△()

Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China

Received:2023-08-14 Revised:2023-10-24 Published:2024-05-15 Online:2024-05-09
Contact: ^△ E-mail：zhangye_hassan@sina.com

韩正怡, 李锐, 陈齐, 王家友, 盛奎, 宋洁, 张野. 收肌管阻滞联合全麻对老年全膝关节置换术患者术后疼痛和认知功能的影响[J]. 天津医药, 2024, 52(5): 523-527.

HAN Zhengyi, LI Rui, CHEN Qi, WANG Jiayou, SHENG Kui, SONG Jie, ZHANG Ye. Effects of ultrasound-guided adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty[J]. Tianjin Medical Journal, 2024, 52(5): 523-527.

摘要/Abstract

摘要：

目的探讨收肌管阻滞联合全身麻醉对老年全膝关节置换术（TKA）患者术后疼痛和认知功能的影响。方法采用随机数字表法将72例需行TKA的老年患者分为对照组和观察组，每组36例。对照组患者采用单纯全身静脉麻醉，观察组在对照组基础上行超声引导下收肌管阻滞，2组患者术后连接静脉自控镇痛泵（PCIA）。记录2组患者入室（T0）、置入喉罩（T1）、手术开始30 min（T2）及术毕（T3）心率（HR）、收缩压（SBP）和舒张压（DBP）。记录术后48 h内疼痛视觉模拟量表（VAS）评分，术后3 d 白细胞介素（IL）-6、C-反应蛋白（CRP）水平和简易精神状态量表（MMSE）评分。记录2组丙泊酚和舒芬太尼用量、PCIA按压次数、苏醒时间、拔管时间、首次下床时间和住院时间。结果与对照组比较，观察组在T1、T2时间点HR降低，SBP和DBP升高（P<0.05）；术后静息及活动后VAS评分、CRP和IL-6水平均降低，而MMSE评分升高（P<0.05）；丙泊酚和舒芬太尼用量、PCIA按压次数、术后苏醒、拔管、首次下床及住院时间均降低（P<0.05）。结论超声引导下收肌管阻滞联合全身麻醉有助于减轻老年全膝关节置换手术患者术后疼痛，缓解应激反应，改善认知水平。

关键词: 关节成形术, 置换, 膝, 神经传导阻滞, 疼痛, 手术后, 炎症, 老年人, 认知功能障碍

Abstract:

Objective To investigate the impact of adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty (TKA). Methods A total of 72 elderly patients undergoing elective TKA were selected and divided into the control group and the observation group with 36 patients in each group using a random number table method. The control group was given simple general intravenous anesthesia, and the observation group received adductor canal block under ultrasound guidance combined with general anesthesia. Both groups of patients were connected to patient-controlled intravenous analgesia (PCIA) pumps after surgery. Data of heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the time of entering the operating room (T0), insertion of the laryngeal mask (T1), 30 minutes after the start of surgery (T2) and the end of surgery (T3). Visual analog scale (VAS) pain scores were recorded in the first 48 hours postoperatively. Levels of C-reactive protein (CRP), interleukin-6 (IL-6) and Mini-Mental State Examination (MMSE) scores were recorded 3 days after surgery. Additionally, the dosage of propofol and sufentanil, PCIA press times, awakening time, extubation time, first time out of bed and length of hospital stay were compared between the two groups. Results Compared with the control group, the observation group showed a decrease in HR at T1 and T3, and an increase in SBP and DBP (P<0.05). In comparison with the control group, the observation group showed lower VAS scores，along with reduced CRP and IL-6 levels，and higher MMSE scores (P<0.05) at the same postoperative time points. Patients in the observation group showed reduced doses of propofol and sufentanil, fewer PCIA presses, shorter postoperative recovery, extubation, first time out of bed and hospital stay than those of patients in the control group (P<0.05). Conclusion The application of ultrasound-guided adductor canal block combination with general anesthesia helps alleviate postoperative pain, relieve stress responses and improve cognitive function level in elderly patients with total knee replacement surgery.

Key words: arthroplasty, replacement, knee, nerve block, pain, postoperative, inflammation, aged, cognitive dysfunction

中图分类号:

R687.42，R614

图/表 7

参考文献 22

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组别	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）
对照组	13/23	70.19±5.00	22.25±3.01	23/13
观察组	11/25	69.11±5.15	22.11±2.95	20/16
χ²或t	0.250	0.906	0.194	0.520

组别	性别（男/女）	年龄/岁	BMI/（kg/m²）	ASA分级（Ⅱ/Ⅲ）
对照组	13/23	70.19±5.00	22.25±3.01	23/13
观察组	11/25	69.11±5.15	22.11±2.95	20/16
χ²或t	0.250	0.906	0.194	0.520

组别	丙泊酚/mg	苏醒时间/min	拔管时间/min	首次下床时间/h	住院时间/d
对照组	582.19±50.62	14.95±3.00	18.20±3.48	51.95±7.11	9.71±4.31
观察组	489.87±52.29	8.87±2.65	10.73±2.84	36.41±6.33	7.58±1.93
t	7.611^＊＊	9.126^＊＊	9.990^＊＊	11.683^＊＊	2.692^＊＊

组别	丙泊酚/mg	苏醒时间/min	拔管时间/min	首次下床时间/h	住院时间/d
对照组	582.19±50.62	14.95±3.00	18.20±3.48	51.95±7.11	9.71±4.31
观察组	489.87±52.29	8.87±2.65	10.73±2.84	36.41±6.33	7.58±1.93
t	7.611^＊＊	9.126^＊＊	9.990^＊＊	11.683^＊＊	2.692^＊＊

组别	HR/（次/min）
组别	T0	T1	T2	T3
对照组	76.39±5.64	97.53±7.91	84.68±4.02	79.72±4.40
观察组	76.13±4.31	95.70±6.59	80.79±3.76	79.76±3.73
组别	SBP/mmHg
组别	T0	T1	T2	T3
对照组	138.72±13.37	108.45±13.01	104.62±16.81	120.07±14.80
观察组	139.15±15.32	115.69±14.76	123.95±11.23	133.10±17.52
组别	DBP/mmHg
组别	T0	T1	T2	T3
对照组	89.76±11.08	73.92±5.67	77.94±7.24	80.62±7.45
观察组	85.81±10.46	79.42±5.22	82.57±6.67	84.83±6.06

收肌管阻滞联合全麻对老年全膝关节置换术患者术后疼痛和认知功能的影响

Effects of ultrasound-guided adductor canal block combined with general anesthesia on postoperative pain and cognitive function in elderly patients undergoing total knee arthroplasty

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组别	静息状态/分
组别	术后6 h	术后12 h	术后24 h	术后48 h
对照组	4.8±1.4	5.2±2.3	4.9±1.2	3.6±1.0
观察组	2.2±0.9	2.9±0.7	2.5±1.2	2.4±1.1
组别	运动状态/分
组别	术后6 h	术后12 h	术后24 h	术后48 h
对照组	5.9±1.2	5.9±1.2	5.3±1.1	4.9±1.2
观察组	3.3±1.3	3.6±1.2	3.6±0.9	3.1±1.1

组别	舒芬太尼总量/μg	PCIA按压次数/次
对照组	162.8±17.3	15.6±5.5
观察组	131.1±16.0	8.6±1.7
t	8.055^＊＊	7.251^＊＊

组别	术前	术后1 d	术后2 d	术后3 d
对照组	28.60±0.97	23.48±4.98	24.75±3.67	27.13±2.44
观察组	28.25±1.00	25.88±3.95	26.56±3.76	27.78±2.16

组别	CRP/（mg/L）
组别	术前	术后1 d	术后3 d
对照组	8.7±1.9	112.4±11.5	159.8±16.0
观察组	8.0±2.0	80.0±10.3	102.8±13.3
组别	IL-6/（ng/L）
组别	术前	术后1 d	术后3 d
对照组	52.24±9.88	136.06±7.70	62.10±6.84
观察组	55.28±8.07	99.78±10.66	56.36±9.60

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