膝关节置换术后不同镇痛方案的疗效评价  

Evaluation of four multimodal analgesic strategies for total knee arthroplasty

作　　者：郇松玮[1] 姚平[2] 刘宁[1] 李劼若[1] 佘国荣[1] 黄炜杰 查振刚[1] 

机构地区：[1]暨南大学附属第一医院关节外科 [2]暨南大学医学院,广州510620

出　　处：《中国矫形外科杂志》2014年第7期601-606,共6页Orthopedic Journal of China

基　　金：广东省科技计划项目(编号:2011B05300013);广东省中医药管理局课题(编号:20111174)

摘　　要：[目的]比较膝关节置换术后四种不同的多模式镇痛方案的疗效。[方法]选取2011年9月～2013年3月行单侧全膝关节置换患者80例，随机分为4组，每组20例。A组：术后予连续股神经阻滞（CFNB）＋术中关节周围浸润镇痛（LIA）＋持续冰疗（CCT）镇痛；B组：术后予CFNB＋LIA；C组：术后予CFNB＋CCT；D组：术后仅予CFNB。采用视觉模拟量表（VAS）评估患者术后6、12、24、48、72h静息时及术后24、48、72h活动时的疼痛情况，并记录术后6、12、24、48、72h各组患肢股四头肌肌力水平，以及术后2—7d时患膝关节主动及被动屈伸活动度；监测术后恶心、呕吐、头晕等药物不良反应及伤口并发症情况。[结果]术后6、12、24、48h，A、B组静息VAS评分均低于C、D组（P〈0．05），C组低于D组（P〈0．05），术后72h，四组静息VAS评分没有统计学差异（P〉0．05）；术后24、48、72h，A、B组活动VAS评分均低于C、D组（P〈0．05），C组低于D组（P〈0．05）。术后各组患肢股四头肌肌力水平无统计学差异（P〉0．05）；术后2—5d，A组、B组的主动活动度均〉C组、D组（P〈0．05），C组〉D组（P〈0．05），术后6—7d四组没有统计学差异（P〉0．05）；术后2～4d，A、B组被动活动度〉C、D组（P〈0．05），C组〉D组（P〈0．05），术后5—7d四组被动活动度没有统计学差异（P〉0．05）；术后A、B组之间的差异均无统计学意义；术后四组不良反应事件差异无统计学意义（P〉0．05）。[结论]连续股神经阻滞联合关节局部浸润镇痛效果良好，有利于TKA术后的早期康复锻炼，其疗效与CFNB＋uA＋CCT无统计学差异，值得进一步临床推广。[ Objective] To compare the analgesic effect of four muhimodal analgesia strategies for total knee arthroplasty （TKA） . [ Methods] Eighty patients scheduled for elective primary unilateral TKA from September 2011 to March 2013 were randomly allocated into four preoperative analgesic groups. Group A received continuous femoral nerve block （CFNB） combined with local infiltration analgesia （LIA） and continuous cryotherapy （CCT）, group B received CFNB plus LIA, group C received CFNB plus CCT, and group D received CFNB. The intensity of pain during activity and at rest was assessed with the visual analog scale （VAS）, and myodynamia of the quadriceps femoris was recorded. VAS and myodynamia were assessed 6, 12, 24, 48, and 72 h postoperatively. Knee range of motion （ROM） was compared from two to seven days after the operation. Adverse drug reactions, such as nausea and vomiting, were also analyzed. [ Results] There was no significant difference between groups A and B. The VAS scores for resting pain in groups A and B were significantly lower than in groups C and D. Furthermore, VAS scores in group C were lower than in group D at 6, 12, 24, and 48 h postoperatively. There were no significant differences between the four groups 72 h postoperatively. In regards to activity pain, VAS scores in groups A and B were significantly lower than in groups C and D. In addition, group C had a lower score than group D at 24, 48, and 72 h postoperatively. In regards to myodynamia, there were no significant differences in the quadriceps femoris between the four groups. In addition, active ROM in groups A and B were significantly larger than groups C and D. Furthermore, active ROM in group C was larger than group D from two to five days postoperatively. There were no significant postoperative changes in passive ROM found. There were also no significant differences in the rate of adverse drug reactions between the four groups. [ Conclusion ] Analgesia through continuous femoral nerve block combined with local infi

关 键 词：膝关节置换术 多模式镇痛 连续股神经阻滞 局部浸润镇痛 持续冰疗 

分 类 号：R614[医药卫生—麻醉学] R687.4[医药卫生—外科学]