连续股神经阻滞与静脉自控镇痛对全膝关节置换术后镇痛效果及关节功能的影响  

Effects of continuous femoral nerve block and intravenous analgesia on postoperative analgesia and joint function after total knee arthroplasty

作　　者：范智芳[1] 

机构地区：[1]河南省三门峡市中心医院疼痛科,472000

出　　处：《中国实用医刊》2017年第16期65-68,共4页Chinese Journal of Practical Medicine

摘　　要：目的对比分析连续股神经阻滞与静脉自控镇痛对全膝关节置换（TKA）术后镇痛效果及关节功能的影响。方法选取择期实施TKA手术患者78例，依据随机数字表法分为研究组与对照组，每组39例。两组均于全身麻醉下实施TKA，研究组全身麻醉前予以连续股神经阻滞镇痛，对照组予以静脉自控镇痛。统计两组术后并发症发生情况、术后镇痛泵按压次数及留院观察时间，并对比手术前后应激指标[空腹血糖（FBG）、白细胞计数（WBC）、C-反应蛋白（CRP）、皮质醇]变化情况及术后不同时段患者静息状态疼痛（RVAS）、运动时疼痛（PVAS）程度及患肢膝关节活动度。结果术后6、24、48h，与对照组相比，研究组PVAS、RVAS评分均较低，差异有统计学意义（P〈0．05）；术后2d、3d、gd、6周，与对照组相比，研究组患肢膝关节活动度均较高，差异有统计学意义（P〈0．05）；术后研究组并发症发生率（7．69％）远低于对照组（25．64％），差异有统计学意义（P〈0．05）；两组术前FBG、WBC、CRP、皮质醇水平比较差异未见统计学意义（P〉0．05）；术后24h与对照组相比，研究组FBG、WBC、CRP、皮质醇水平均明显较低，差异有统计学意义（P〈0．05）；与对照组相比，研究组术后镇痛泵按压次数较少，留院观察时间较短，差异有统计学意义（P〈0．05）。结论连续股神经阻滞应用于TKA术后镇痛中，镇痛效果显著，应激反应小，可有效提高TKA患者患肢关节活动度，减少术后镇痛泵按压次数，缩短留院观察时间，且安全性较高。Objectiv e To compare the effects of continuous femoral nerve block and intravenous analgesia on postoperative analgesia and joint function after total knee arthroplasty （TKA）. Methods Seventy-eight patients undergoing elective TKA surgery were divided into study group and control group according to random number table method, with 39 cases in each group. Both groups were all in the implementation of TKA, the study group were treated by continuous femoral nerve block analgesia before general anesthesia, the control group was given intravenous controlled analgesia. The postoperative complications, postoperative analgesia pump pressing times and stay in hospital for observation between the two groups, the stress indexes [ fasting blood glucose （FBG）, white blood cell count （WBC）, C reactive protein （CRP） ], resting pain patients in different periods and changes in cortisol （RVAS）af- ter surgery, degree of pain during exercise （PVAS） and limb knee joint activity were compared between the two groups before and after operation. Results After 6, 24 and 48 hours, compared with the control group, the RVAS and PVAS scores of the study group were all lower, and the differences were significant （P 〈 0. 05）. After 2 days, 3 days, 4 days, 6 weeks, compared with the control group, the study group had a higher degree of activity of the knee joint, the differences were significant （ P 〈 0. 05 ）. The incidence of postoperative complications in the study group was significantly lower than that in the control group （25.64%）, and the difference was significant （P 〈 0. 05 ）. There was no significant difference in FBG, WBC, CRP or cortisol levels between the two groups （P 〉 0.05 ）. Compared with the control group, the levels of FBG, WBC, CRP and cortisol in the study group were significantly lower than those in the control group, the differences were significant （P 〈 0. 05）. Compared with the control group, the study group had less pressure on the pump after the operation, the

关 键 词：连续股神经阻滞 静脉自控镇痛 全膝关节置换术 镇痛效果 关节功能 

分 类 号：R614[医药卫生—麻醉学]