目的: 探讨布托啡诺超前应用联合超声引导下多点阻滞在膝关节置换术中的应用。方法: 选取2020年1月—2022年7月在本院行膝关节置换术的108例患者,随机分为两组（研究组54例,对照组54例）。两组均采取超声引导下多点神经阻滞麻醉,另研究组在神经阻滞前10分钟静脉注射20 μg/kg布托啡诺,对照组给予等量的生理盐水。比较布托啡诺注射前（T0）、布托啡诺注射后10分钟（T1）、多点阻滞后15分钟（T2）、多点阻滞后30分钟（T3）以及手术结束时（T4）的心率（HR）、平均动脉压（MAP）,比较痛觉神经阻滞起效时间与维持时常、术中其他麻醉药物使用情况;比较术后疼痛视觉模拟量表（VAS）、舒适度状态量表（BCS）评分;比较不良事件并发率。结果: 研究组T1、T2、T3时的HR、MAP均低于T0,T2时的HR、MAP均低于T1,其余时间点两两比较差异无统计学意义;对照组T2、T3时的HR、MAP均低于T0、T1,其余时间点两两比较差异无统计学意义;两组各时间点间HR、MAP比较差异无统计学意义;与对照组比较,研究组痛觉神经阻滞起效时间短,痛觉神经阻滞持续时间长,术中芬太尼使用率低;与对照组相比较,研究组术后2h、4h的静息VAS评分低,而BCS评分增高;研究组苏醒期躁动发生率相较于对照组下降。结论: 在膝关节置换术中采取布托啡诺超前应用联合超声引导下多点阻滞,术中血流平稳,镇痛效果佳,可减轻患者术后近期疼痛感及提升其舒适度,减少苏醒期躁动。
Abstract
Objective To explore the application of advanced butorphanol combined with ultrasound guided multi-point block in knee replacement. Methods 108 patients who underwent knee replacement in our hospital from January 2020 to July 2022 were selected and divided into two groups (54 cases in the study group and 54 cases in the control group). Both groups were anesthetized by multi-point nerve block under the guidance of ultrasound, and the study group intravenous injection 20μg/kg butorphanol at 10 minutes before nerve block, but the equal amount of normal saline was implemented in the control group. The heart rate (HR) and mean arterial pressure (MAP) were compared before butorphanol injection (T0), 10min after butorphanol injection (T1), 15min after multi-point block (T2), 30min after multi-point block (T3) and at the end of operation (T4), and the onset and duration of pain nerve block and use of other anesthetics during operation were compared, and the scores of visual analogue scale (VAS) and Bruggrmann comfort scal (BCS) at different time points after surgery were compared, and the adverse events during and after operation were also compared. Results The HR and MAP at T1, T2 and T3 in the study group were lower than T0, which at T2 were lower than T1, and there was no statistically significant difference in pairs at other time points. The HR and MAP at T2 and T3 in the control group were lower than those at T0 and T1, but there was no statistically significant difference in pairs at other time points. There was no significant difference in HR and MAP between the two groups at each time point. Compared with the control group, the onset time of pain nerve block in the study group was short, and the duration of pain nerve block was long, while the use rate of fentanyl during operation was low. Compared with the control group, the resting VAS scores at 2h and 4h after operation in the study group were lower, while the BCS scores were higher. The rate of restlessness in the study group was lower compared with control group. Conclusion In the knee joint replacement operation, the use of butorphanol in advance combined with multi-point block under ultrasound guidance has stable blood flow during the operation and good analgesic effect, and it can reduce the short-term pain of patients after the operation, improve their comfort, and reduce restlessness during the awakening period.
关键词
膝关节置换术 /
布托啡诺 /
超前镇痛 /
多点阻滞 /
疼痛
Key words
knee joint replacement /
butorphanol /
preemptive analgesia /
multipoint block /
pain
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