【摘要】 目的评价七氟醚预处理对全膝关节置换术(TKA)患者早期康复的影响。方法择期全麻下拟行初次单侧TKA患者30例,随机均分为七氟醚预处理组(S组)和对照组(C组)。S组在止血带充气前吸入1 MAC七氟醚30min,而C组患者只吸入纯氧。记录两组患者术后6h、1、3、5、7和14dVAS疼痛评分。测量术前、术后1、3、7及14d患肢小腿肿胀程度(腓肠肌周径)、膝关节周径(髌骨上极)及股四头肌肿胀程度(髌骨上缘近侧4横指处),分别计算术前与术后周径的增加率。记录两组患者术后1、3、7、14d直腿抬高度数及两组患者术后3、7、14、30d关节自主活动度。结果 C组患者术后1、3、7及14d小腿肿胀程度、膝关节周径及股四头肌肿胀增加率均明显大于S组(P<0.05);C组患者术后6h、1、3、5、7dVAS疼痛评分明显高于S组(P<0.05);S组患者术后1、3、7、14d直腿抬高度数明显高于C组(P<0.05);S组患者术后3、7、14及30d膝关节自主活动度均高于C组(P<0.05)。结论七氟醚预处理可减轻TKA手术患者止血带诱发下肢缺血-再灌注损伤,可显著提高患者早期康复质量。更多还原

【Abstract】 Objective To investigate the effects of sevoflurane preconditioning on early recovery in patients undergoing total knee arthroplasty.Methods Thirty patients who were performed first time TKA on unilateral knee were randomly divided into 2groups(n=15each):control group(group C)and sevoflurane preconditioning group(group S).Group S inhaled sevoflurane with the end-tidal concentration corresponding to 1MAC for 30 min before use using of tourniquet,while in group C,the patients only inhaled 100%O2.Severity of postoperative swelling,pain scores by visual analogue scale(VAS),range of motion and muscle strength were recorded and compared between the 2groups.Results Swellings of the calf,the knee and the quadriceps at 1,3,7and 14 dafter surgery were all significantly more severe in group C than in group S(P<0.05).The VAS pain scores at 6h,1,3,5,7dwere significantly higher in group C than in group S(P<0.05),but there was no significant difference in the VAS pain score at 14 dbetween the 2groups.Group S had a significantly greater range of spontaneous activity of the knee at 3,7,14 dand 1month after surgery than group C(P<0.05);Straight leg raising at 1,3,7,14 dwas also significantly better in group S than in group C(P<0.05).Conclusion Sevoflurane preconditioning can reduce a tourniquet-induced lower extremity ischemia-reperfusion injury and improve the early recovery quality in patients undergoing total knee arthroplasty.更多还原