实用医学杂志 ›› 2023, Vol. 39 ›› Issue (6): 696-700.doi: 10.3969/j.issn.1006⁃5725.2023.06.007

• 临床研究 • 上一篇    下一篇

收肌管阻滞联合静脉自控镇痛对全膝关节置换术患者术后抑郁状态的影响 

王露1 王鑫1 张婷1 高晗2    

  1. 1 徐州市中心医院麻醉科(江苏徐州 221009);2 徐州医科大学附属宿迁医院(南京鼓楼医院集团宿迁医 院)(江苏宿迁 223800)

  • 出版日期:2023-03-25 发布日期:2023-03-25
  • 通讯作者: 高晗 E⁃mail:ghmz1203@sina.com
  • 基金资助:
    国家自然科学基金项目(编号:82001169)

Effect of adductor canal block combined with intravenous patient ⁃ controlled analgesia on postoperative depression in patients undergoing total knee arthroplasty 

WANG Lu,WANG Xin,ZHANG Ting,GAO Han.   

  1. Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221009,China

  • Online:2023-03-25 Published:2023-03-25
  • Contact: GAO Han E⁃mail:ghmz1203@sina.com

摘要:

目的 探讨收肌管阻滞(ACB)联合静脉自控镇痛(PCIA)对行全膝关节置换术患者术后 抑郁状态的影响。方法 选择行全膝关节置换术的患者随机分为 ACB 联合 PCIA 组(A 组)40 例和 PCIA 组(B 组)40 例。B 组术后给予 PCIA 镇痛方法,A 组在 B 组基础上术前联合 ACB 镇痛。记录术后 2 h (T1)、6 h(T2)、12 h(T3)、24 h(T4)、72 h(T5)静息和运动 VAS 评分,术后补救镇痛药物使用情况,恶心呕 吐发生情况,术前、术后 1 d、术后 3 d 医院焦虑抑郁量表(HADS)评分。结果 A 组患者 T1 ~ T4时静息和 运动 VAS 评分明显低于 B 组(P < 0.05);A 组患者术后补救镇痛药物使用量明显减少(P < 0.05),恶心 呕吐发生率明显降低(P < 0.05);A 组患者术后 1 d HADS 评分及术后出现显著的抑郁症状(HADS⁃D ≥ 8 的患者比例明显低于 B 组(P < 0.05);术后 1 d HADS 评分与 T1 ~ T4时静息和运动 VAS 评分呈明显正相 关(P < 0.05);术后 3 d HADS 评分与 T1 ~ T3 时静息和运动 VAS 评分呈明显正相关(P < 0.05)。结论 ACB 联合 PCIA 相比单纯 PCIA 在全膝关节置换术后镇痛效果更加显著,并可减少术后抑郁的发生,促 进患者快速康复。

关键词:

收肌管阻滞, 静脉自控镇痛, 全膝关节置换术, 术后抑郁

Abstract:

Objective To investigate the effect of adductor canal block(ACB)combined with patient⁃con⁃ trolled intravenous analgesia(PCIA)on postoperative depression in patients undergoing total knee arthroplasty. Methods Eighty patients undergoing total knee replacement were randomly divided into ACB plus PCIA group (Group A)and PCIA group(group B),with 40 cases in each group. Group B were given PCIA after operation while group A was given ACB before operation additionally. The Visual Analogue Scale(VAS)score at resting and during movement were recorded at 2 h(T1),6 h(T2),12 h(T3),24 h(T4),72 h(T5)after operation. The use of remedial analgesics after operation and the incidence of nausea and vomiting were recorded. The hospital anxiety and depression scale(HADS)score was recorded before operation,1 day and 3 days after operation. Results The VAS scores at resting and during movement from T1 to T4 in group A were significantly lower than those in group B(P < 0.05). In group A,the use of remedial analgesics and the incidence of nausea and vomiting after operation were significantly reduced(P < 0.05). In group A,the HADS score 1 day after operation and the propor⁃ tion of patients with significant depressive symptoms(HADS⁃D ≥ 8)were significantly lower than those in group B (P < 0.05). There was significant positive correlation between HADS score 1 day after operation and VAS score at resting and during movement from T1 to T4(P < 0.05). There was significant positive correlation between HADS score 3 days after operation and VAS score at resting and during movement from T1 to T3(P < 0.05). Conclusion ACB combined with PCIA is more effective than PCIA alone after total knee arthroplasty,and can reduce the occur⁃ rence of adverse emotions and promote rapid recovery of patients.

Key words:

adductor canal block, patient controlled intravenous analgesia, total knee replacement, postoperative depression