组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (5): 480-.

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坐骨神经与膝关节囊后间隙联合收肌管阻滞对老年患者全膝关节置换术后影响的观察

  

  • 出版日期:2023-10-09 发布日期:2023-11-01

Application of IPACK (interspace between the popliteal artery and the capsule of the posterior knee blocks) combined with adductor canal block and sciatic nerve block combined with adductor canal block in analgesia after total

knee arthroplasty in elderly people

  • Online:2023-10-09 Published:2023-11-01

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摘要：

　目的　观察超声引导下坐骨神经阻滞（SNB）联合收肌管阻滞（ACB）与膝关节囊后间隙阻滞（IPACK）联
合 ACB 对行全膝关节置换术（TKA）的老年患者的应用效果，及其对血流动力学、炎症反应、术后早期功能恢复的影响。
方法　采用随机数字表法将 108 例行 TKA 的老年患者分为对照组（54 例）和观察组（54 例），分别采取超声引导下
股骨外侧入路 SNB 联合 ACB，超声引导下远端 IPACK 联合 ACB。监测指标：患者围术期生命体征变化，术后苏醒时间，
术后不良反应发生率；比较术后 6 h（T1）、12 h（T2）、24 h（T3）的白细胞介素 -6（IL-6）、白细胞介素 -1β（IL-1β）、
基质金属蛋白酶 3（MMP3）、超敏 C 反应蛋白（hs-CRP）水平 ；比较 T1、T2、T3 时疼痛数字评分（NRS）、致痛物
质 P 物质（SP）；比较术后 48 h 的 Lysholm 评分、西大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。结果
观察组患者切皮、扩髓和术毕时的收缩压（SBP）、舒张压（DBP）、心率（HR）显著低于对照组（P<0.05）；观察组
患者麻醉苏醒时间、自主呼吸恢复时间、恢复室停留时间均显著短于对照组（P<0.05）；观察组患者不良反应（恶心、
呕吐、低氧血症等）发生率显著低于对照组（P<0.05）；观察组 T1、T2、T3 时 IL-6、IL-1β、MMP3、hs-CRP 水平
均显著低于同时间对照组水平（P<0.05）；观察组 T1、T2、T3 时的 NRS 评分、SP 水平均显著低于对照组（P<0.05）；
术后 48 h 观察组 Lysholm 评分高于对照组，WOMAC 评分低于对照组（P<0.05）。结论　超声引导下远端 IPACK 联
合 ACB 能够显著缩短老年患者 TKA 术后恢复时间，维持术中血流动力学稳定，减轻炎性状态和术后疼痛程度，减
少不良反应，效果优于超声引导下股骨外侧入路 SNB 联合 ACB。

关键词:

Abstract:

Objective　To investigate the effect of ultrasound-guided interspace between popliteal artery and capsule of the
posterior knee (IPACK) blocks combined with adductor canal block and sciatic nerve block combined with adductor canal block
in elderly patients undergoing total knee arthroplasty (TKA). Methods　This study was a prospective study. The clinical data
of 108 elderly patients undergoing unilateral TKA were included. The patients were randomly divided into two groups: the observation group received IPACK combined with adductor canal block, the control group received sciatic nerve block combined
with adductor canal block, with 54 cases in each group. Outcome measures including: Changes of vital signs, recovery time,
incidence of related adverse reactions; Expression levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), matrix metalloproteinase 3 (MMP3), high sensitivity C-reactive protein (hs-CRP) at 6, 12, 24 h after operation; Numerical rating scale (NRS)
pain score and substance P (SP) at 6, 12, 24 h after operation; Lysholm score and WOMAC score at 48 h after operation were 
compared. Results　The changes of vital signs in the two groups were compared, the systolic blood pressure (SBP), diastolic
blood pressure (DBP) and heart rate (HR) in the observation group were lower than those in the control group (P<0.05); The
recovery time, recovery time of postoperative spontaneous respiration, and PACU stay time of the observation group were
shorter than those of the control group (P<0.05); The incidence of adverse reactions including nausea, vomiting and hypoxemia
in the observation group were lower than those in the control group (P<0.05); The levels of IL-6, IL-1β, MMP3 and hs-CRP
in the observation group at 6, 12, 24 h after operation were lower than those in the control group (P<0.05); The resting and
exercise NRS pain scores and substance P in the observation group were significantly lower than those in the control group
(P<0.05); The Lysholm scores in the observation group at 48 h after operation were higher than those in the control group,
but the WOMAC scores in the observation group at 48 h after operation were lower than those in the control group (P<0.05).
Conclusion　IPACK combined with adductor canal block for elderly patients undergoing TKA surgery has a good analgesic
effect, it can help the patients to reduce their recovery time, maintain the stability of hemodynamics, alleviate inflammatory
response, improve the pain control and reduce the occurrence of adverse reaction, which is better than the sciatic nerve block
combined with adductor canal block.

Key words:

Total knee arthroplasty