超声下神经阻滞技术在骨科手术中的应用研究
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摘要
目的 :研究超声下神经阻滞技术在骨科手术中的应用效果。方法 :选择2015年10月～2017年10月期间在我院接受骨科手术治疗的40例患者作为观察对象,根据术后镇痛方案不同分成对照组、研究组,各20例。对照组患者术毕接受静脉镇痛泵进行镇痛治疗,研究组患者术后于超声引导下开展股神经阻滞镇痛治疗。对比感觉神经与运动神经阻滞的起效时间、维持时间、术后疼痛程度、不良反应发生率。结果 :研究组患者术后感觉神经、运动神经的起效时间均低于对照组,但维持时间均高于对照组,差异有统计学意义;研究组患者术后4h、12h、24h的疼痛VAS评分均低于对照组,差异有统计学意义;研究组患者术后不良反应发生率10.0%(2/20)低于对照组的40.0%(8/20),差异有统计学意义。结论 :超声下神经阻滞技术在骨科手术中的应用效果显著,安全性高,具有起效时间快、维持时间长等优势,能有效减轻患者术后疼痛,值得临床推广。
Objective To study the application effect of ultrasound-based nerve block technique in orthopedic surgery.Methods 40 cases of patients who underwent orthopedic surgery in our hospital from October 2015 to October 2017 were selected as the subjects of this study. All the patients were divided into control group and study group according to different postoperative analgesia plans, with 20 cases in each group. The patients in the control group received analgesia pump for analgesia after surgery, and the patients in the study group underwent ultrasound-guided analgesia with femoral nerve block after surgery. The onset time, duration, postoperative pain, and adverse reaction rate of sensory and motor nerve block were compared.Results The onset time of sensory nerve and motor nerve in the study group was lower than that in the control group, but the maintenance time was higher than that in the control group, and the difference was statistically significant; The VAS scores of pain in the study group at 4 h, 12 h, and 24 h were lower than those in the control group. The incidence of adverse reactions in the study group was 10.0%(2/20) lower than that in the control group(40.0%, 8/20), and the difference was statistically significant.Conclusion The application of ultrasonic nerve block technique in orthopedic surgery is effective. It has high safety, quick onset time and long maintenance time. It can effectively reduce postoperative pain and is worthy of clinical promotion.
Objective To study the application effect of ultrasound-based nerve block technique in orthopedic surgery.Methods 40 cases of patients who underwent orthopedic surgery in our hospital from October 2015 to October 2017 were selected as the subjects of this study. All the patients were divided into control group and study group according to different postoperative analgesia plans, with 20 cases in each group. The patients in the control group received analgesia pump for analgesia after surgery, and the patients in the study group underwent ultrasound-guided analgesia with femoral nerve block after surgery. The onset time, duration, postoperative pain, and adverse reaction rate of sensory and motor nerve block were compared.Results The onset time of sensory nerve and motor nerve in the study group was lower than that in the control group, but the maintenance time was higher than that in the control group, and the difference was statistically significant; The VAS scores of pain in the study group at 4 h, 12 h, and 24 h were lower than those in the control group. The incidence of adverse reactions in the study group was 10.0%(2/20) lower than that in the control group(40.0%, 8/20), and the difference was statistically significant.Conclusion The application of ultrasonic nerve block technique in orthopedic surgery is effective. It has high safety, quick onset time and long maintenance time. It can effectively reduce postoperative pain and is worthy of clinical promotion.
引文
[1]王俊喜.腰丛坐骨神经联合阻滞麻醉在下肢手术中的应用效果分析[J].中国实用神经疾病杂志, 2017, 20(4):70-71.
[2]张湘东.超声引导下腰丛联合坐骨神经阻滞与腰-硬联合麻醉对膝关节镜手术患者血流动力学及麻醉效果的对比[J].中国实用神经疾病杂志, 2015, 18(02):109-110, 111.
[3]何崎,秦燕,刘丹凤,等.股神经联合坐骨神经阻滞麻醉用于老年单侧下肢手术的麻醉效果及对血流动力学的影响[J].现代生物医学进展, 2016, 16(6):1144-1146.
[4]裴冬杰,屈双权.超声引导下的神经阻滞在小儿麻醉中的进展[J].中国医师杂志, 2017, 19(1):159-160,封3.
[5]Vallejo MC, Ramesh V, Phelps AL, et al. Epidural labor analgesia:continuous infusion versus patient-controlled epidural analgesia with background infusion versuss without a background infusion[J]. J Pain,2014, 8(12):970-975.
[6]楼洁,陈彩艳,沈文生.超声引导下神经阻滞联合全身麻醉在下肢骨折手术中的应用[J].医学研究杂志, 2017, 46(3):174-177.
[7]雷鸣,朱涛,周棱,等.超声引导下神经阻滞的临床应用及研究进展[J].广东医学, 2017, 38(8):1294-1298.
[8]王靖宇,徐文强,顾奕,等.超声结合神经刺激仪引导下股神经联合坐骨神经阻滞在下肢手术中的临床评价[J].浙江临床医学,2017, 19(8):1531-1532, 1544.
[9]卢承志,田友芳,姚猛飞,等.超声引导下老年患者肌间沟臂丛神经阻滞麻醉的临床观察[J].临床军医杂志, 2014, 42(11):1159-1161.
[10]张云慧,顾新宇,刘清仁,等.超声引导神经阻滞复合全身麻醉在胫骨骨折手术中的应用[J].临床麻醉学杂志, 2015, 31(3):228-230.
[11]王权光,陈丽梅,刘乐,等.超声引导前路坐骨神经和股神经阻滞在膝关节以下骨折手术中的应用[J].温州医科大学学报, 2016,46(11):818-821, 825.
[12]文四成,陈潜沛,欧阳天纬,等.不同浓度罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的麻醉效果[J].临床麻醉学杂志, 2014,30(05):472-475.
[13]李明,戴晓蓉,朱雁鸿,等.超声引导联合神经刺激器在上肢臂丛神经阻滞的临床研究[J].昆明医科大学学报, 2014, 35(12):137-140.
[14]张国强,翁灿辉,吴寿和.神经刺激仪引导下肌间沟连续镇痛联合腋路臂丛神经阻滞在单侧上肢手术患者中应用[J].中国实用神经疾病杂志, 2016, 19(08):78-79.
[15]韩斌,徐铭军,张明,等.罗哌卡因、舒芬太尼单独或混合用药连续蛛网膜下腔阻滞用于分娩镇痛效果的比较[J].中华麻醉学杂志,2016, 36(11):1309-1312.
[16] Liu ZQ, Chen XB, Li HB, et al. A comparison of remifentanil parturient-controlled intravenousanalgesia with epidural analgesia:a meta-analysis of randomized controlled trials[J]. Anesth Analg, 2014,118(03):598-603.
[17]王倩倩,王耀岐,静广建.不同剂量右美托咪定和咪达唑仑用于臂丛神经阻滞的效果比较[J].国际麻醉学与复苏杂志, 2016, 37(9):777-781.
[18]范方华.连续臂丛神经阻滞在上肢手术中及术后镇痛中的应用[J].浙江实用医学, 2016, 21(6):442-443.
[19]于国军,杨富林,陆化梅.股神经阻滞和收肌管阻滞对全膝关节置换术后镇痛及关节功能的影响[J].广东医学, 2017, 38(7):1075-1077, 1081.
[2]张湘东.超声引导下腰丛联合坐骨神经阻滞与腰-硬联合麻醉对膝关节镜手术患者血流动力学及麻醉效果的对比[J].中国实用神经疾病杂志, 2015, 18(02):109-110, 111.
[3]何崎,秦燕,刘丹凤,等.股神经联合坐骨神经阻滞麻醉用于老年单侧下肢手术的麻醉效果及对血流动力学的影响[J].现代生物医学进展, 2016, 16(6):1144-1146.
[4]裴冬杰,屈双权.超声引导下的神经阻滞在小儿麻醉中的进展[J].中国医师杂志, 2017, 19(1):159-160,封3.
[5]Vallejo MC, Ramesh V, Phelps AL, et al. Epidural labor analgesia:continuous infusion versus patient-controlled epidural analgesia with background infusion versuss without a background infusion[J]. J Pain,2014, 8(12):970-975.
[6]楼洁,陈彩艳,沈文生.超声引导下神经阻滞联合全身麻醉在下肢骨折手术中的应用[J].医学研究杂志, 2017, 46(3):174-177.
[7]雷鸣,朱涛,周棱,等.超声引导下神经阻滞的临床应用及研究进展[J].广东医学, 2017, 38(8):1294-1298.
[8]王靖宇,徐文强,顾奕,等.超声结合神经刺激仪引导下股神经联合坐骨神经阻滞在下肢手术中的临床评价[J].浙江临床医学,2017, 19(8):1531-1532, 1544.
[9]卢承志,田友芳,姚猛飞,等.超声引导下老年患者肌间沟臂丛神经阻滞麻醉的临床观察[J].临床军医杂志, 2014, 42(11):1159-1161.
[10]张云慧,顾新宇,刘清仁,等.超声引导神经阻滞复合全身麻醉在胫骨骨折手术中的应用[J].临床麻醉学杂志, 2015, 31(3):228-230.
[11]王权光,陈丽梅,刘乐,等.超声引导前路坐骨神经和股神经阻滞在膝关节以下骨折手术中的应用[J].温州医科大学学报, 2016,46(11):818-821, 825.
[12]文四成,陈潜沛,欧阳天纬,等.不同浓度罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的麻醉效果[J].临床麻醉学杂志, 2014,30(05):472-475.
[13]李明,戴晓蓉,朱雁鸿,等.超声引导联合神经刺激器在上肢臂丛神经阻滞的临床研究[J].昆明医科大学学报, 2014, 35(12):137-140.
[14]张国强,翁灿辉,吴寿和.神经刺激仪引导下肌间沟连续镇痛联合腋路臂丛神经阻滞在单侧上肢手术患者中应用[J].中国实用神经疾病杂志, 2016, 19(08):78-79.
[15]韩斌,徐铭军,张明,等.罗哌卡因、舒芬太尼单独或混合用药连续蛛网膜下腔阻滞用于分娩镇痛效果的比较[J].中华麻醉学杂志,2016, 36(11):1309-1312.
[16] Liu ZQ, Chen XB, Li HB, et al. A comparison of remifentanil parturient-controlled intravenousanalgesia with epidural analgesia:a meta-analysis of randomized controlled trials[J]. Anesth Analg, 2014,118(03):598-603.
[17]王倩倩,王耀岐,静广建.不同剂量右美托咪定和咪达唑仑用于臂丛神经阻滞的效果比较[J].国际麻醉学与复苏杂志, 2016, 37(9):777-781.
[18]范方华.连续臂丛神经阻滞在上肢手术中及术后镇痛中的应用[J].浙江实用医学, 2016, 21(6):442-443.
[19]于国军,杨富林,陆化梅.股神经阻滞和收肌管阻滞对全膝关节置换术后镇痛及关节功能的影响[J].广东医学, 2017, 38(7):1075-1077, 1081.