脉冲式注射在连续收肌管阻滞用于膝关节术后镇痛中的疗效评价  

Effect of Pulsed Injection on Continuous Adductor Block for Postoperative Analgesia after Total Knee Joint Operation

作　　者：王翔锋[1] 罗慧琴 汤雯中 陈亭亭[1] 卢浩杰[1] 刘光辉[1] WANG Xiangfeng;LUO Huiqin;TANG Wenzhong;CHEN Tingting;LU Haojie;LIU Guanghui(The People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350004,China)

机构地区：[1]福建中医药大学附属人民医院,福建福州350004

出　　处：《康复学报》2018年第5期15-20,共6页Rehabilitation Medicine

基　　金：国家自然科学基金面上项目(81774369);福建省自然科学基金项目(2016J01575);福建省康复产业研究院技术创新平台项目(2015Y2001-37)

摘　　要：目的:评价脉冲式注射(PI)和恒速式注射(CSI)在连续收肌管阻滞用于膝关节术后镇痛的效果。方法:选择拟行全膝关节置换术的患者60例,采用随机数字表法分为脉冲式注射组(简称脉冲组)和恒速式注射组(简称恒速组),每组30例。2组术后均行连续收肌管阻滞,使用首次剂量(0.17%罗哌卡因+0.2μg/mL舒芬太尼)10 mL。恒速组在首次剂量注入后即刻开始恒速式注射,背景剂量6 mL/h;脉冲组在首次剂量注入后60 min开始脉冲式注射,脉冲剂量为6 mL/60 min;2组均设置患者自控镇痛(PCA)10 mL/次,锁定时间30min。记录2组患者在术后不同时间点的疼痛视觉模拟评分(VAS评分)、股四头肌肌力及术后恢复指标,记录PCA使用情况及其并发症。结果:与恒速组比较,脉冲组在术后12、24、36、48 h静息和运动时的疼痛VAS评分更低(P<0.05);2组在股四头肌肌力改善方面比较差异无统计学意义(P>0.05);脉冲组术后第1、2天步行的距离、主动弯曲度、PCA按压次数明显优于恒速组(P<0.05);2组的术后并发症比较差异无统计学意义(P>0.05)。结论:脉冲式注射连续收肌管阻滞的镇痛效果确切,并发症少,是一种有效的膝关节手术术后镇痛方法。Objective:To evaluate the analgesic effect of pulsed injection (PI)and constant speed injection (CSI)in continuous adductor block on knee joint postoperative analgesia.Methods:Sixty patients undergoing total knee replacement were randomly divided into PI group and CSI group according to digital table method with 30 cases in each group.Both groups were received continuous femoral nerve block after operation.The prime dose (0.17.% ropivacaine+0.2μg/mL sufentanil)was 10 mL.In the CSI group,continuous dose was started right after prime dose injection,with a background dose of 6mL/h;in the PI group,the pulse dose was 6mL/ h 60 minutes after prime dose;Both groups were set up PCA 10 mL each time,lock time was 30 minutes.Pain,visual analogue scale (VAS score),muscle strength of quadriceps and recovery index after operation of both groups were recorded at different time points. PCA usage and its complications were also recorded.Results:Compared with those of the CSI group,VAS scores of the PI group were lower when patients accessed at rest or exercise at 12,24,36 and 48 hours after surgery respectively (P<0.05),and there was no significant difference in muscle strength of quadriceps between two groups (P>0.05).The distance of walking,active bending and PCA pressing times of the PI group were significantly better than those of the CSI group (P<0.05).There was no significant difference in postoperative complications between two groups (P>0.05).Conehtsion:Pulse injection continuous adductor block would be a more effective analgesic method after knee joint operation,with definite analgesic effect and less complication.

关 键 词：术后镇痛 脉冲式注射 恒速式注射 连续收肌管阻滞 人工全膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]