| 摘要: |
| ［摘要］ 目的 观察远端入路膝关节囊后间隙阻滞对老年全膝关节置换术（TKA）患者围术期血流动力学及苏醒质量的影响。方法 招募2019年10月至2021年10月延安大学附属医院收治的老年TKA患者84例，采用随机数字表法将其分为观察组和对照组，每组42例。对照组采用近端入路膝关节囊后间隙阻滞，观察组采用远端入路膝关节囊后间隙阻滞。比较两组围术期［完成阻滞后（T1）、手术开始后10 min（T2）、关节置换时（T3）、术毕（T4）］血流动力学指标、苏醒质量、术后镇痛效果、膝关节活动度及不良反应发生率。结果 在T1～T4时间点，观察组平均动脉压（MAP）、心率（HR）低于对照组，差异有统计学意义（P<0.05）。观察组自主呼吸恢复时间、呼之睁眼时间、完全清醒时间均短于对照组，差异有统计学意义（P<0.05）。在术后12 h、24 h、48 h，观察组运动及静息状态视觉模拟量表（VAS）评分低于对照组，差异有统计学意义（P<0.05）。在术后12 h、24 h、48 h，观察组膝关节活动度大于对照组，差异有统计学意义（P<0.05）。两组术后不良反应发生率比较差异无统计学意义（9.52% vs 11.90%； χ2=0.000，P=1.000）。结论 远端入路膝关节囊后间隙阻滞能有效调节老年TKA患者的围术期血流动力学，提高苏醒质量，术后镇痛效果好，有利于患者术后快速康复。 |
| 关键词: 全膝关节置换术 老年 远端入路 膝关节囊后间隙阻滞 血流动力学 苏醒质量 |
| DOI：10.3969/j.issn.1674-3806.2023.09.13 |
| 分类号:R 614.4 |
| 基金项目:延安市科技计划项目（编号：SL2019ZCSY-002，SL2019ZCSZ-003）；陕西省社会发展科技攻关项目（编号：2016SF-075） |
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| Observation on the effects of infiltration between the popliteal artery and capsule of the posterior knee block through distal approach on perioperative hemodynamics and recovery quality in elderly patients undergoing total knee arthroplasty |
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SU Hong-li, LI Ling-xia, LIU Yan-ling, et al.
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Department of Anesthesiology, Affiliated Hospital of Yan′an University, Shaanxi 716000, China
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| Abstract: |
| ［Abstract］ Objective To observe the effects of infiltration between the popliteal artery and capsule of the posterior knee block through distal approach on perioperative hemodynamics and recovery quality in elderly patients undergoing total knee arthroplasty(TKA). Methods Eighty-four elderly patients with TKA who were admitted to the Affiliated Hospital of Yan′an University from October 2019 to October 2021 were recruited and divided into observation group and control group by random number table method, with 42 cases in each group. The control group underwent infiltration between the popliteal artery and capsule of the posterior knee block through proximal approach, while the observation group underwent infiltration between the popliteal artery and capsule of the posterior knee block through distal approach. The hemodynamic indexes during the perioperative period［after completion of block(T1), 10 minutes after operation(T2), at the time of joint replacement(T3) and at the end of the operation(T4)］, quality of recovery, postoperative analgesic effect, range of motion of joints and incidence of adverse reactions were compared between the two groups. Results At the T1-T4 time points, the mean arterial pressure(MAP) and heart rate(HR) in the observation group were lower than those in the control group, and the differences were statistically significant(P<0.05). The time of spontaneous breathing recovery, eye opening time and full waking time in the observation group was shorter than that in the control group, and the difference was statistically significant(P<0.05). The Visual Analogue Scale(VAS) scores at exercise and at resting state in the observation group were lower than those in the control group 12, 24 and 48 hours after operation, and the differences were statistically significant(P<0.05). The ranges of motion of joints in the observation group were greater than those in the control group 12, 24 and 48 hours after operation, and the differences were statistically significant(P<0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups(9.52% vs 11.90%; χ2=0.000, P=1.000). Conclusion Infiltration between the popliteal artery and capsule of the posterior knee block through distal approach can effectively regulate perioperative hemodynamics and improve recovery quality in elderly patients undergoing TKA, and their postoperative analgesic effects are good, which is conducive to rapid recovery of the patients after surgery. |
| Key words: Total knee arthroplasty(TKA) Old age Distal approach Infiltration between the popliteal artery and capsule of the posterior knee block Hemodynamics Recovery quality |
