股神经+坐骨+股外侧皮神经阻滞在膝关节骨性关节炎关节镜术中的作用分析

Analysis of the effect of femoral nerve + sciatic + lateral femoral cutaneous nerve block in arthroscopy of knee osteoarthritis

摘要:

目的 探讨股神经+坐骨+股外侧皮神经阻滞在膝关节骨性关节炎（KOA）关节镜术中的作用。方法 选取2019年5月－2021年10月该院收治的拟行膝关节镜术治疗的KOA患者86例，依据随机数表法分为观察组和对照组，每组43例。对照组行连续硬膜外麻醉，观察组行股神经+坐骨+股外侧皮神经阻滞麻醉。比较两组患者的运动和感觉阻滞起效时间及持续时间，记录并比较两组患者的麻醉效果、麻醉前（T₀）、麻醉后5 min（T₁）、手术10 min（T₂）、手术30 min（T₃）和手术结束时（T₄）的心率（HR）、平均动脉压（MAP）和不良反应总发生率。结果 观察组运动和感觉神经阻滞起效时间较对照组短（P < 0.05），运动和感觉神经阻滞维持时间较对照组长（P < 0.05）；两组患者HR和MAP在组间、时间和交互方面比较，差异均有统计学意义（P < 0.05）；对照组的HR在T₀时点与T₁时点、T₁时点与T₃时点比较，差异均有统计学意义（P < 0.05），MAP在T₀时点与T₁、T₂、T₃和T₄时点以及T₁时点与T₃时点比较，差异均有统计学意义（P < 0.05）；观察组患者T₁、T₂、T₃和T₄时点的MAP高于对照组（P < 0.05）；在不良反应方面，观察组发生率较对照组低（P < 0.05）。结论 股神经+坐骨+股外侧皮神经阻滞能够提高患者在KOA关节镜术中的麻醉效果，阻滞效果理想，可维持血流动力学稳定，降低不良反应发生率。值得临床推广应用。

Abstract:

Objective To explore the effect of femoral nerve + sciatic+lateral femoral cutaneous nerve block in arthroscopy of knee osteoarthritis (KOA).Methods 86 patients with KOA who planned to be treated by knee arthroscopy from May 2019 to October 2021 were selected and divided into observation group and control group according to random number table method, with 43 cases in each group. The control group received continuous epidural anesthesia, while the observation group was anesthetized by femoral nerve + sciatic + lateral femoral cutaneous nerve block. The onset time and duration time of motor and sensory block were compared between the two groups, and the effects of anesthesia and heart rate (HR) and mean arterial pressure (MAR) were compared before anesthesia (T₀), 5 min after anesthesia (T₁), 10 min after the start of surgery (T₂), 30 min after the start of surgery (T₃) and at the end of operation (T₄), and the incidence of total adverse reactions was also compared.Results The onset time of motor and sensory nerve block in the observation group were shorter than that in the control group (P < 0.05), and the duration time of motor and sensory nerve block in the observation group were longer than that in the control group (P < 0.05). There were significant differences in the HR and the MAP among groups, time and interaction (P < 0.05), and there were statistically significant differences in HR between T₀ and T₁ and T₁ and T₃ in the control group (P < 0.05), and there were statistically significant difference in MAP between T₀ and T₁, T₂, T₃, T₄, as well as T₁ and T₃ (P < 0.05). The MAP at T₁, T₂, T₃ and T₄ in the observation group were higher than those in the control group (P < 0.05). In terms of adverse reactions, the incidence of observation group was lower than that of control group (P < 0.05).Conclusion Femoral nerve + sciatic + lateral femoral cutaneous nerve block can improve the anesthetic effect of patients in arthroscopy of KOA, and the blocking effect is ideal, which can maintain hemodynamic stability, and reduce the incidence of adverse reactions.