超声引导连续股神经阻滞用于全膝关节置换术后镇痛的临床疗效观察  

Observation on the Clinical Effect of Ultrasound Guided Continuous Femoral Nerve Block for Total Knee Arthroplasty Postoperative Analgesia

作　　者：夏德国[1] 高巨[1] 纪维[1] 龙丰云[1] 杨柳青[1] 

机构地区：[1]江苏省苏北人民医院麻醉科,江苏扬州225001

出　　处：《医学综述》2015年第9期1688-1690,共3页Medical Recapitulate

摘　　要：目的观察超声引导连续股神经阻滞用于全膝关节置换术(TKA)术后镇痛的临床疗效。方法选取2013年2月至2014年3月在江苏省苏北人民医院诊治的单侧TKA患者48例,按照随机数字表法分为超声组(24例)和对照组(24例)。手术后,超声组行超声引导连续股神经阻滞,对照组行患者静脉自控镇痛,持续镇痛2 d。在此期间,记录两组各时间段的静息及运动状态时的疼痛视觉模拟评分法(VAS)评分,并对两组肌力评分、不良反应、满意度进行观察。结果超声组1、2、4、12、48 h静息疼痛VAS评分分别为(3.4±1.9)分、(3.1±1.8)分、(4.7±1.8)分、(2.4±1.7)分、(2.8±1.9)分、(1.9±1.5)分,与对照组对应时间段(6.4±1.3)分、(6.2±1.1)分、(6.2±1.0)分、(6.1±1.2)分、(5.4±1.0)分、(3.5±1.2)分比较差异有统计学意义(P<0.05);而1、2、4、12、48 h超声组动态的疼痛VAS评分分别为(5.3±1.6)分、(4.8±1.5)分、(4.4±1.3)分、(4.3±1.2)分、(4.6±1.8)分、(3.4±1.3)分,与对照组对应时间段(7.4±1.2)分、(7.5±1.3)分、(7.5±1.2)分、(7.3±1.1)分、(6.6±1.1)分、(5.5±1.2)分比较差异均有统计学意义(P<0.05)。超声组满意度为87.5%(21/24),对照组满意度为33.3%(8/24),差异有统计学意义(P<0.05)。术后镇痛2 d内,超声组和对照组不良反应发生率分别为12.5%(3/24)和45.8%(11/24),超声组明显低于对照组(P<0.05)。结论在临床TKA术后镇痛中,超声引导连续股神经阻滞的镇痛效果较静脉自控镇痛好,且不良反应小。Objective To observe the clinical efficacy of ultrasound-guided continuous femoral nerve block （CFNB） for total knee arthroplasty （TKA） postoperative analgesia. Methods A total of 48 patients who received unilateral TKA admitted to the Northern Jiangsu People＇s Hospital from Feb. 2013 to Mar. 2014 were divided into two groups according to random number table method：ultrasound group（ 24 cases） and control group（24 cases）. After the operation, the ultrasound group underwent ultrasound guided ropiva- caine CFNB, the control group received patient self-controlled intravenous analgesia, the analgesia was contin- ued for two days. Pain score under rest and passive movement, visual analogue scale（ VAS）, muscle strength and side effects were recorded during analgesia. Results The VAS score of resting state at 1,2,4,12,24,48 those in ultrasound group （3.4 ± 1.9,3.1 ± 1.8,4.7 ± 1.8,2.4 ± 1.7,2. 8 ± 1.9,1.9 ± 1.5 ） were lower than those in the control group（6. 4 ± 1.3,6.2 ± 1.1,6.2 ± 1.0,6. 1 ± 1.2,5.4 ± 1.0,3.5 ± 1.2） （P 〈 0.05 ） ;The VAS score of motion state at 1,2,4,12,24,48 h （5.3 ± 1.6,4.8 ± 1.5,4.4 ± 1.3,4.3 ± 1, 2, 4. 6 ± 1.8,3.4 ± 1.3 ） in ultrasound group were lower than the control group （7.4 ± 1.2,7.5 ± 1.3,7.5 ± 1.2,7.3 ± 11 1,6.6 ± 1. 1, 5.5 ± 1.2 ） （ P 〈 0. 05 ）. The satisfaction of ultrasound group was higher than the control group（87.5% vs 33.3% ） ,the difference was statistically significant （P 〈0. 05 ）. Within 2 days of postoperative analgesia, the incidence of adverse reactions of ultrasound group was significantly lower than the control group （ 12.5 % vs 45. 8 % ） （ P 〈 0. 05 ）. Conclusion In the clinical TKA analgesia, the analgesic efficacy of CFNB guided by ultrasound is better than patient self-controlled intravenous analgesia,and the ad- verse reactions are less as well.

关 键 词：连续股神经阻滞 超声引导 全膝关节置换术 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]