全膝关节置换术后应用连续股神经阻滞镇痛和静脉自控镇痛的效果比较  

The analgesic efficacy of continuous femoral nerve block and continuous intravenous analgesia after total knee replacement: an one-year-follow-up study

作　　者：高升焘 孙爱娟 张鹏 万连平 杜建春 

机构地区：[1]青岛市骨伤科医院关节一科,266021 [2]青岛市骨伤科医院麻醉科,266021

出　　处：《中华关节外科杂志（电子版）》2012年第1期36-39,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的比较连续股神经阻滞镇痛(CFNB)和静脉患者自控镇痛(PCIA)在全膝关节置换手术(TKA)围手术期的镇痛效果及术后1年膝关节功能评估的随访结果。方法选取2008年11月至2009年10月因膝关节骨关节炎行TKA的患者60例,数字随机分成2组,每组30例(n=30)。分别给予PCIA和CFNB作为术后镇痛方式。两组患者均采用腰麻联合硬膜外麻醉方式。在围手术期,采用视觉模拟(VAS)评分法观察患者的疼痛评分。记录吗啡累计用量,观察患肢肌力,初次下地时间及镇痛相关并发症等指标。在术后1年随访时,根据膝关节学会评分系统(KSS)对患者膝关节功能进行评估。结果在术后6、12、24、36、48h静息状态下,CFNB组的疼痛评分(VAS评分)均比PCIA组明显低(P<0.05)。术后24h,48h进行膝关节持续被动活动(CPM)时累计吗啡用量均比PCIA组明显低(P<0.05)。嗜睡、恶心呕吐等不良反应也低于PCIA组。术后1年,两组在膝关节功能评价方面无显著差异(P>0.05)。结论 CFNB在TKA术中的初期镇痛效果优于PCIA。与PCIA相比,CFNB患者术后不良反应较少,膝关节功能恢复更好,患者的满意程度更高。为TKA术后镇痛策略中一种安全、实用和有效的方法。术后1年,两组患者在功能评估方面无统计学差异。Objective To compare the analgesic effects of continuous femoral nerve block analgesia （CFNB） and intravenous patient-controlled analgesia （PCIA） after total knee replacement surgery, and evaluate the knee function in one-year-follow-up study postoperatively. Methods From November 2008 to October 2009,60 patients undergoing unilateral total knee replacement were randomized into two groups, 30 cases each （ n = 30）. PCIA was given for postoperative analgesia and CFNB as another way. All patients received spinal anesthesia combined with epidural anesthesia. In the perioperative period, Visual analogue scale （VAS） was used to evaluate perioperative pain score. Total amount of morphine, muscle strength of limb, the time of first ambulation and analgesic associated complications were observed and recorded. All the patients were followed up for one year, using Knee Society scoring system （KSS） to assess knee function. Results In six, 12, 24, 36, 48 hours postoperative resting state, pain score （VAS） of CFNB group was significantly lower than that of PCIA group （P 〈 0.05 ）. During the continuous passive movement （CPM） of knee postoperatively at 24 and 48 hours, the dosage of cumulative morphine of CFNB group was significantly lower than that of CIA group （P 〈 0. 05 ）. Adverse reactions such as lethargy, nausea and vomiting were also fewer in the CFNB group. No significant difference was found in knee function evaluation of two groups at one year follow-up （P 〉 0. 05 ）. Conclusions CFNB has superior early analgesic effect to PCIA in total knee replacement surgery, as well as fewer adverse reactions,better knee function recovery, and higher patient satisfaction. CFNB is a safe, practical and effective method for analgesia after TKA.

关 键 词：关节成形术 置换 膝 股神经病 麻醉 静脉 

分 类 号：R614[医药卫生—麻醉学]