三种不同镇痛技术用于全膝关节置换术术后的镇痛效果比较  

Comparison of three postoperative analgesia for total knee arthroplasty

作　　者：杨竹青[1] 张睿[2] 卓长淑 连庆泉[1] 狄美琴 YANG Zhuqing ZHANG Rui ZHUO Changshu LIAN Qingquan DI Meiqing(Department of Anesthesiology, the Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou 325027, China Department of Orthopaedic, the Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou 325027, China)

机构地区：[1]温州医科大学附属第二医院麻醉科,浙江温州325027 [2]温州医科大学附属第二医院骨科,浙江温州325027

出　　处：《中国医药导报》2017年第13期69-72,共4页China Medical Herald

基　　金：浙江省医学会立项课题(2015ZYC-A29)

摘　　要：目的比较患者静脉自控镇痛(PCIA)、患者硬膜外自控镇痛(PCEA)和连续股神经阻滞(CFNB)3种镇痛技术用于全膝关节置换术(TKA)术后镇痛效果及不良反应。方法根据相应纳入标准回顾性收集2010年1月~2016年8月温州医科大学附属第二医院TKA患者,依据术后镇痛方式的不同分为PCIA、PCEA和CFNB三组,再随机从每组中各抽取80例患者。记录三组患者术后随访的VAS评分及不良反应等情况。结果三组一般资料比较,差异均无统计学意义(P>0.05)。镇痛效果比较:静息状态和活动状态下三组各时点VAS评分差异均有高度统计学意义(P<0.01);组间比较显示,CFNB组静息状态和活动状态下各时点VAS评分均明显低于PCIA组和PCEA组(P<0.05)。不良反应比较:三组患者总不良反应发生率差异有统计学意义(P<0.05),CFNB组总不良反应发生率显著低于PCIA组和PCEA组(P<0.05),其中,CFNB组术后镇痛不全发生率(2.50%)明显低于PCIA组(15.00%)和PCEA组(13.75%)。结论 CFNB组术后镇痛效果优于PCIA组和PCEA组,同时CFNB组不良反应发生率明显低于PCEA组和PCIA组。Objective To compare analgesia effects and adverse events among patient-controlled intravaneous analgesia （PCIA）, patient-controlled epidural analgesia （PCEA） and continuous peripheral nerve block （CPNB） after total knee arthroplasty （TKA）. Methods Patients underwent TKA in the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to August 2016 who met inclusion and exclusion criteria were retrospectively collected, and divided into three groups of PCIA, PCEA and CFNB according to the postoperative analgesia methods. Then randomly extracted 80 patients from each group, and postoperative follow-up VAS scores and adverse reactions were recorded and ana- lyzed. Results The demographic information in three groups showed no significant difference （P 〉 0.05）. As for analge- sia effects, there were significant differences in VAS scores among the three groups in the state of rest and activity at every points （P 〈 0.01）; comparison among groups, patients＂ VAS scores of group CFNB were lower than those of group PCIA and group PCEA regardless of the state of rest or activity at every points （P 〈 0.05）. As for adverse effects, the in- cidence of adverse reactions in the three groups was statistically significant （P 〈 0.05）, and the incidence of adverse events was significantly lower in the CFNB group than that in the PCIA and PCEA groups （P 〈 0.05）. Moreover, the in- cidence of postoperative inadequate analgesia in CFNB group （2.50%） was lower than that in PCIA group （15.00%） and PCEA group （13.75%）. Conclusion The postoperative analgesia effect in CFNB group is superior to PCIA group and PCEA group, and adverse effect in CFNB group is obviously lower than PCEA group and PCIA group.

关 键 词：全膝关节置换术 患者自控镇痛 连续股神经阻滞 疼痛评分 

分 类 号：R614[医药卫生—麻醉学]