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目的:探讨超声引导下收肌管阻滞在儿童膝关节镜手术中的应用价值。方法:选择2010-2016年来温州医科大学附属第二医院育英儿童医院行单侧膝关节镜手术的患儿40例,年龄5~12岁,患儿ASA分级为I-II级,手术时间均在90min之内。按随机数字表分为对照组和观察组,每组20例。在全身麻醉诱导完成后,对照组加用超声引导股神经阻滞,观察组加用超声引导收肌管阻滞,均予0.25%罗哌卡因0.4ml/kg。评估患儿术后两天步行时的疼痛程度和步行距离,采用徒手肌力检查分级评估股四头肌肌力,记录分级为0-2级肌力减弱发生率,并记录术后恶心、呕吐、苏醒延迟等不良反应的发生情况。结果:与对照组比较,观察组术后两天行走时疼痛比较差异无统计学意义(P>0.05),但行走距离明显延长,股四头肌肌力减弱率明显降低(P<0.05),两组患儿不良反应发生差异无统计学意义(P>0.05)。结论:超声引导下收肌管阻滞能加快患儿膝关节镜手术后的功能锻炼,有助于患儿康复。
Objective: To investigate the value of ultrasound-guided muscular tube block in children’s knee arthroscopy. Methods: From 2010 to 2016, 40 children with unilateral knee arthroscopy at the Second Affiliated Hospital of Wenzhou Medical University were enrolled in this study. The age ranged from 5 to 12 years. The children with ASA were classified as grade I-II. The operation time was Within 90min. By random number table divided into control group and observation group, 20 cases in each group. After the induction of general anesthesia was completed, the control group with ultrasound-guided femoral nerve block, the observation group plus ultrasound-guided muscular tube block, both 0.25% ropivacaine 0.4ml / kg. The degree of pain and walking distance were evaluated during walking two days after operation. Muscle strength of quadriceps femoris was evaluated by manual muscle strength examination. The incidence of weakness of grade 0-2 was recorded and the postoperative nausea and vomiting were recorded , Wake up delay and other adverse reactions. Results: Compared with the control group, there was no significant difference in pain when walking in two days after operation in the observation group (P> 0.05), but the walking distance was significantly longer, and the weakened strength of quadriceps femoris was significantly decreased (P <0.05) There was no significant difference in adverse reactions between the two groups (P> 0.05). Conclusion: Ultrasound-guided muscular tube block can accelerate functional exercise after knee arthroscopy in children and help children recover.