布托啡诺超前应用联合膝关节周围神经阻滞对膝关节置换术患者镇痛及术后恢复的影响

Effect of butorphanol preadministration combined with peripheral nerve block of knee joint on analgesia and postoperative recovery of knee joint replacement patients

摘要:

目的 分析布托啡诺超前应用联合膝关节周围神经阻滞对膝关节置换术患者镇痛及术后恢复的影响。方法 选取2022年5月—2023年9月榆林市中医医院收治的74例膝关节置换术患者。按照不同麻醉方法分对照组（36例）与观察组（38例），两组均给予膝关节周围神经阻滞，对照组在神经阻滞基础上给予舒芬太尼，观察组在神经阻滞前给予布托啡诺，对比两组麻醉效果。结果 观察组与对照组在麻醉前（T₀）、阻滞5 min（T₁）、阻滞15 min（T₂）时平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂）、呼吸频率、视觉模拟评分法（VAS）比较，采用重复测量设计的方差分析，结果 ①不同时间点MAP、HR、SPO₂、呼吸频率、VAS评分比较，差异均有统计学意义（P <0.05）；②观察组与对照组MAP、HR、SPO₂、呼吸频率、VAS评分比较，差异均有统计学意义（P <0.05），观察组MAP、HR、SPO₂、呼吸频率、VAS评分较稳定，镇痛效果、血流动力学平稳较好；③两组MAP、HR、SPO₂、呼吸频率、VAS评分随时间变化趋势比较，差异均有统计学意义（P <0.05）。观察组术后4、12 h BCS、VAS评分的差值均高于对照组。观察组痛觉神经阻滞起效时间短于对照组，痛觉神经阻滞维持时间长于对照组（P <0.05）。观察组与对照组不良反应总发生率的比较，差异无统计学意义（P >0.05）。观察组补救镇痛率低于对照组（P >0.05）。观察组自制镇痛泵按压次数少于对照组（P <0.05）；观察组术后补救镇痛率小于对照组（P <0.05）。观察组术前与术后1个月Lysholm评分、膝骨性关节炎严重性指数（ISOA）评分、膝关节前屈活动度、膝关节后伸活动度的差值均优于对照组（P <0.05）。结论 超前应用布托啡诺联合膝关节周围神经阻滞可有效减轻膝关节置换术患者疼痛，减少按压次数和降低补救镇痛率，提高患者舒适度，维持血流动力学稳定。

Abstract:

Objective To analyze the effects of butorphanol preadministration combined with peripheral nerve block of knee joint on analgesia and postoperative recovery in patients with knee joint replacement.Methods 74 patients with knee replacement treated in Yulin Hospital of Traditional Chinese Medicine from May 2022 to September 2023 were selected and divided into 2 groups according to different anesthesia methods. Both groups were given peripheral knee nerve block, 36 patients in the control group were given sufentanil, and 38 patients in the observation group were given butofenol before nerve block. The anesthetic effect of the two groups was compared.Results The average arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂), respiratory rate and visual pain analogue (VAS) scores were compared between the observation group and the control group before anesthesia (T₀), 5 min (T₁) and 15 min (T₂) after anesthesia, and the variance analysis with repeated measurement design was used. The results were as follows: MAP, HR, SPO₂, respiratory rate and VAS scores at different time points showed statistically significant differences (P <0.05). There were significant differences in MAP, HR, SPO₂, respiratory rate and VAS scores between the observation group and the control group (P <0.05), the fluctuations of MAP, HR, SPO₂, respiratory rate and VAS score in the observation group were stable, and the analgesic effect and hemodynamics were stable. There were significant differences in MAP, HR, SPO₂, respiratory rate and VAS scores between the two groups (P <0.05). Comparison of the difference of comfort Status Scale (BCS) score and VAS score between the observation group and the control group at 4 h and 12 h after surgery showed statistically significant differences (P <0.05); The BCS and VAS scores of the observation group were lower than those of the control control group at 12 h after operation. The onset time and maintenance time of pain nerve block between the observation group and the control group were statistically significant (P <0.05). The onset time of pain nerve block in observation group was shorter than that in control group, and the duration of pain nerve block was longer than that in control group. There was no significant difference in the total incidence of adverse reactions between the observation group and the control group (P >0.05). There was no significant difference in the rate of relief analgesia between the observation group and the control group (P <0.05). The comparison of the times of self-made analgesic pump between the observation group and the control group was statistically significant (P <0.05). The number of postoperative analgesia in observation group was lower than that in control group. The difference of Lysholm score, severity index of knee osteoarthritis (ISOA) score, knee anterior flexion motion and knee posterior extension motion between the observation group and the control group before and one month after surgery was statistically significant (P <0.05). The difference of Lysholm score, ISOA score, knee flexion motion and knee extension motion in observation group before and 1 month after operation were better than those in control group.Conclusion The advanced application of butorphanol combined with peripheral nerve block of knee joint can effectively reduce the pain of patients with knee joint replacement, reduce the number of analgesia and compression, improve the comfort of patients, and maintain hemodynamic stability.