广州医科大学学报

目的:探究B超引导下股神经阻滞对老年人全膝关节置换术的认知功能及术后早期康复的影响。方法:回顾性分析本院2017年1月-2020年6月进行全膝关节置换术老年患者100例,根据其神经阻滞方式不同分组,对照组采取全麻治疗(n=46),观察组采取B超引导下股神经阻滞(n=54),对比两组术前、术后6 h、12 h、1 d、3 d的MMSE评分、VAS评分、患肢肌力、膝关节最大屈曲和外展活动度及不良反应发生率。结果:观察组在术后6 h、12 h、1 d、3 d的MMSE评分均高于对照组(P均<0.05);观察组在术后6 h、12 h、1 d、3 d的VAS评分均低于对照组(P均<0.05);观察组在术后6 h、12 h、1 d的患肢肌力评分明显高于对照组(P均<0.05);观察组在术后12 h、1 d、3 d的膝关节最大外展活动度及最大屈曲度大于对照组(P均<0.05);两组在不良反应发生率上的差异无统计学意义(P>0.05)。结论:B超引导下股神经阻滞对于老年膝关节置换术的阻滞效果较好,对患者的认知功能影响小,可以提供更优越的早期镇痛效果,并发症发生率低,对患者的康复具有积极意义。

Objective:To investigate the effect of femoral nerve block guided by B-ultrasound on the cognitive function and early postoperative rehabilitation of elderly patients with total knee arthroplasty.Methods:The clinical data of 100 elderly patients underwent total knee arthroplasty between January 2017 and June 2020 in our hospital was retrospective analyzed. According to the different types of nerve block,the control group was treated with general anesthesia(n=46),and the study group was treated with B-ultrasound guided femoral nerve block(n= 54). The MMSE score,VAS score,muscle strength of the affected limb,maximum flexion and abduction activity of knee joint and incidence of adverse reactions in the two groups at baseline and at 6 h,12 h,1 d and 3 d after the operation were compared.Results:The MMSE scores in the study group at 6 h,12 h,1 d,and 3 d after the operation were higher than those in the control group(allP<0.05). The VAS scores in the study group at 6 h,12 h,1 d,and 3 d were lower than those in the control group(allP<0.05). The muscle strength score of the affected limb in the study group at 6 h,12 h and 1 d after the operation was significantly higher than that in the control group(allP<0.05). The maximum flexion and abduction activity of knee joint in the study group at 12 h,1 d and 3 d after the operation were greater than those in the control group(allP<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:B-ultrasound guided femoral nerve block is effective in elderly knee replacement surgery with less influence on cognitive function. It provides better early analgesic effect with low incidence of complications,and it is positive in the rehabilitation of patients.