| 杨圣泽,王立伟.超声引导下高位踝关节阻滞对急性踝关节骨折患者术后恢复质量的影响[J].安徽医药,待发表. |
| 超声引导下高位踝关节阻滞对急性踝关节骨折患者术后恢复质量的影响 |
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| 投稿时间：2024-02-27 录用日期：2024-04-16 |
| DOI： |
| 中文关键词: 外周神经阻滞 踝关节骨折 加速康复外科 术后恢复质量 |
| 英文关键词: |
| 基金项目:江苏省医学重点学科建设项目（JSDW202231)；江苏省老年健康科研项目（LKZ2023016）；徐州市医学重点人才项目（XWRCHT20220051);徐州市科技计划面上项目（KC21055) |
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| 中文摘要: |
| 目的：评价超声引导下高位踝关节阻滞（High ankle block, HAB）对急性踝关节骨折患者术后恢复质量的影响。方法：选取因急性踝关节骨折行切开复位内固定术的患者78例（受伤时间至手术时间均≤24h），性别不限，年龄18~80岁，BMI 18~28kg/m2，ASA分级I~II级。采用随机数字表法将患者分为两组：HAB组（H组，n=39)和对照组（C组，n=39)。H组患者行超声引导下患侧高位踝关节阻滞复合全身麻醉；C组患者行单纯全身麻醉。两组全麻方案相同，术后均行静脉自控镇痛（PCIA）。于入室前、术后24h、48h使用QoR-15评分量表评估患者恢复质量，并测定血清 IL-6、IL-1β、TNF-α水平；记录术后返回病房时、6h、24h、48h静息和活动时NRS疼痛评分；统计术中瑞芬太尼消耗量、术后48h氢吗啡酮消耗量及补救镇痛情况；记录术后返回病房时踝关节运动阻滞发生情况、术后不良反应（术后恶心呕吐、头晕、谵妄、呼吸抑制等）及神经阻滞相关并发症（穿刺部位血肿、感染、神经损伤等）发生率；记录首次下地时间和住院时间总时间。结果：H组术后24、48 h QoR-15评分明显高于C组，血清IL-6、IL-1β、TNF-α水平明显低于C组( P＜0.05)；H组术后6h、24h静息及活动时 NRS 疼痛评分明显低于C组( P＜0. 05)，术中瑞芬太尼消耗量、术后48h氢吗啡酮消耗量及术后补救镇痛率明显低于C组 ( P＜0. 05)；H组首次下床时间、术后住院时间明显短于C组( P＜0.05)；其他指标两组差异无统计学意义。结论：超声引导下高位踝关节阻滞可以显著提高急性踝关节骨折患者术后恢复质量。在完整的保留踝关节的运动功能的前提下，减少围术期阿片类药物使用、降低术后疼痛水平及炎症反应，有助于患者早期进行术后康复锻炼。为加速康复外科理念在踝关节骨折中的应用提供了新的思路。 |
| 英文摘要: |
| Objective: To evaluate the effect of ultrasound-guided high ankle block (HAB) on postoperative recovery quality in patients with acute ankle fracture. Methods: 78 patients who underwent open reduction and internal fixation due to acute ankle fracture (injury time to operation time ≤24h) were selected. They were of all genders, aged 18-80 years, BMI 18-28kg /m2, ASA grade I to II. Patients were divided into two groups using random number table method: HAB group (group H, n=39) and control group (group C, n=39). Patients in group H underwent ultrasound-guided high ankle block combined general anesthesia on the affected side. Patients in group C underwent simple general anesthesia. The general anesthesia program was the same in both groups, and controlled intravenous analgesia (PCIA) was performed after surgery. QoR-15 score scale was used to evaluate the recovery quality of patients before, 24h and 48h after surgery, and serum levels of IL-6, IL-1β and TNF-α were measured. NRS pain scores were recorded at 6h, 24h, 48h at rest and during activity upon return to the ward. The intraoperative consumption of remifentanil, the postoperative consumption of hydromorphone 48h and the state of relief and analgesia were analyzed. The incidence of ankle movement block, postoperative adverse reactions (postoperative nausea, vomiting, dizziness, delirium, respiratory depression, etc.) and complications related to nerve block (puncture site hematoma, infection, nerve injury, etc.) were recorded when returning to the ward after surgery. The time of first landing and total length of hospital stay were recorded.Results: The QoR-15 score of group H was significantly higher than that of group C at 24 and 48 h after operation, and the serum levels of IL-6, IL-1β and TNF-α were significantly lower than those of group C (P < 0.05). The NRS pain score at rest and activity at 6h and 24h after operation in group H was significantly lower than that in group C (P < 0.05), the intraoperative remifentanil consumption, the postoperative hydromorphone consumption at 48h and the postoperative analgesia rate were significantly lower than those in group C (P < 0.05). The time of first getting out of bed and postoperative hospitalization in group H were significantly shorter than those in group C (P < 0.05). There was no significant difference in other indexes between the two groups. Conclusion: Ultrasound-guided high ankle block can significantly improve the postoperative recovery quality of patients with acute ankle fracture. On the premise of preserving the motor function of the ankle, reducing the use of perioperative opioids, reducing the postoperative pain level and inflammatory response will help patients to carry out postoperative rehabilitation exercise in the early stage. It provides a new idea for the application of accelerated rehabilitation surgery in ankle fracture. |
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