江伟群+陶晓三

[摘要]目的 研究坐骨神经阻滞（SNB）联合超声引导下连续股神经阻滞（CFNB）对单侧全膝关节置换术老年患者应激反应的影响。方法 选取2016年3～10月于我院行单侧全膝关节置换术老年患者56例，根据镇痛方式将56例患者分为对照组（单纯全麻）及观察组（坐骨神经阻滞联合超声引导下连续股神经阻滞）。分别于麻醉诱导前（T1）、手术切皮时（T2）、手术30 min（T3）、手术结束时（T4）及术后1 h（T5）监测患者的血流动力学水平及应激相关激素浓度。结果 两组患者T2时MAP及HR水平明显低于T1时，差异有统计学意义（P<0.05）；观察组T3及T5时的MAP及HR水平明显低于同时刻对照组，差异有统计学意义（P<0.05）；观察组T2、T3、T4及T5时的COR、AD及NE水平明显低于对照组同时刻，差异有统计学意义（P<0.05）。结论 SNB联合CFNB有助于维持单侧全膝关节置换术老年患者术中血流动力学稳定，抑制应激反应，临床上值得推广。

[关键词]神经阻滞；股神经；单侧全膝关节置换术；应激反应

[中图分类号] R614.4 [文献标识码] A [文章编号] 1674-4721（2017）08（b）-0117-03

Influence of sciatic nerve block combined with ultrasound-guided continuous femoral nerve block on stress responseelderly in patients undergoing unilateral total knee arthroplasty

JIANG Wei-qun TAO Xiao-san

Department of Anesthesiology，the Third Affiliated Hospital of Nanchang University，Jiangxi Province，Nanchang 330008，China

[Abstract]Objective To study the influence of sciatic nerve block （SNB） combined with ultrasound-guided continuous femoral nerve block （CFNB） on stress responseelderly in patients undergoing unilateral total knee arthroplasty.Methods 56 elderly cases underwent unilateral total knee arthroplasty by our hospital from March to October 2016 were selected and were divided into control group （general anesthesia） and observation group （SNB combined with ultrasound-guided CFNB）. The level of hemodynamics and stress related hormones were monitored before anesthesia induction （T1），surgical resection （T2），30 min of operation （T3），at the end of surgery （T4） and postoperative 1 h （T5）.Results MAP and HR level on T2 of two groups were significantly lower than T1，the difference was statistically significant （P<0.05）；MAP and HR level on T3 and T5 of the observation group were significantly lower than the control group at the same time，the difference was statistically significant （P<0.05）.COR，AD and NE levels on T2，T3，T4 and T5 of the observation group were significantly lower than the control group at the same time，the difference was statistically significant （P<0.05）.Conclusion SNB combined with CFNB is helpful to maintain hemodynamic stability and suppress stress response in elderly patients undergoing unilateral total knee arthroplasty.

[Key words]Nerve block；Femoral nerve；Unilateral total knee arthroplasty；Stress response

隨着人口老龄化的加剧，越来越多老年患者出现膝关节相关疾病。单侧全膝关节置换术有助于改善膝关节功能，是临床常见的手术之一[1-2]。对于老年患者而言，手术属于强烈的刺激，不仅存在生理上的负担，更有心理上的恐惧[3]。这一系列因素均会导致患者神经内分泌、免疫调节及代谢功能等产生相应的变化，称为应激反应。有效镇痛有助于减轻患者的应激反应，保证手术的顺利进行[4]。为此，我院采取坐骨神经阻滞（sciatic nerve block，SNB）联合超声引导下连续股神经阻滞（continuous femoral nerve block，CFNB）对单侧全膝关节置换术老年患者进行镇痛，取得良好效果，具体如下。endprint

1资料与方法

1.1 一般资料

选取2016年3～10月于我院行单侧全膝关节置换术老年患者56例，根据镇痛方式将56例患者分为对照组及观察组。对照组28例，男性16例，女性12例；年龄62～84岁，平均（74.10±5.27）岁；……