摘要目的 研究超声引导下连续隐神经阻滞联合多模式镇痛在膝关节置换术中的应用效果。方法 选择2018年6月～2019年6月中信惠州医院收治的50 例膝关节置换术患者作为研究对象，按照随机数字表法分为对照组和研究组，各组25 例。对照组采用连续隐神经阻滞，研究组采用连续隐神经阻滞联合多模式镇痛。观察两组患者镇痛药物使用情况、膝关节评分系统（HSS）、Berg 平衡量表（BBS）、术后情况与舒适度（BCS）、生活质量量表（GQOL-74）评分。结果 两组的顺式阿曲库铵与双氯芬酸钠用量比较，差异无统计学意义（P＞0.05）；研究组的瑞芬太尼、七氟醚用量高于对照组，差异有统计学意义（P＜0.05）。两组的术前HSS、BBS 评分比较，差异无统计学意义（P＞0.05）；研究组术后30 d 的HSS、BBS 评分高于对照组，两组术后30 d 的HSS、BBS 评分高于术前，差异有统计学意义（P＜0.05）；研究组术后下地时间、住院时间短于对照组，研究组首次步行距离长于对照组，研究组术后4、8 h 的BCS 评分高于对照组，差异有统计学意义（P＜0.05）；两组患者手术前GQOL-74 评分的比较，差异无统计学意义（P＞0.05）；研究组术后30 d 的GQOL-74 评分高于对照组，两组患者术后30 d 的GQOL-74 评分高于术前，差异有统计学意义（P＜0.05）。结论 膝关节置换术中，可实施超声引导下连续隐神经阻滞联合多模式镇痛，可有效缩短患者住院时间，并改善患者膝关节功能，镇痛情况理想，值得应用。
Abstract：Objective To study the application of ultrasound-guided continuous saphenous nerve block plus multimode analgesia during knee replacement.Methods A total of 50 patients with knee replacement admitted to CITIC Huizhou Hospital from June 2018 to June 2019 were selected as the research objects.According to random number table method,they were divided into the control group and the research group,with 25 cases in each group.The control group received the continuous saphenous nerve block,and the research group received the continuous saphenous nerve block and multi-mode analgesia.Analgesia usage,Hospital for special surgery(HSS),Berg Balance Scale(BBS),Bruggrmann Comfort Scale(BCS)and Generic Quality of Life Inventory-74(GQOL-74)scores were observed in the two groups.Results Comparison of Cis-atracurium and Diclofenac Sodium dosage between two groups,the differences were not statistically significant(P＞0.05).The dosage of Remifentanil and Sevoflurane in the research group were higher than that in the control group,the differences were statistically significant(P＜0.05).Before surgery,HSS and BBS scores between groups showed no statistically significant differences(P＞0.05).The HHS and BBS scores of the research group were higher than those of the control group 30 days after operation,and the HHS and BBS scores of the two groups 30 days after operation were higher than those before operation,the differences were statistically significant(P＜0.05).The ambulation time and hospitalization time in the research group were shorter than those of control group,the walk distance was longer than that of control group,the BCS score of the research group was higher than that of the control group at 4 and 8 hours after operation,the differences were statistically significant(P＜0.05).There was no significant difference in GQOL-74 score between the two groups before operation before surgery(P＞0.05).At 30 days after operation,the GQOL-74 score of the reswarch group was higher than that of the control group,and the GQOL-74 score of the two groups were higher than those before operation,the differences were statistically significant(P＜0.05).Conclusion During knee replacement,the ultrasound-guided continuous saphenous nerve block combined with multi-mode analgesia can efficiently shorten the hospitalization time,and improve the knee joint function and analgesia effects.It is worthy of application.
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