两种不同镇痛方式对全膝关节置换术后膝关节功能康复影响的研究及疼痛管理  

Comparison and pain management of effect of postoperative function rehabilitation between continuous local infiltration analgesia and continuous femoral nerve block after total knee arthroplasty

作　　者：职红 胡靖 蔡枭 李辉 叶久敏 李翠翠 Zhi Hong;Hu Jing;Cai Xiao;Li Hui;Ye Jiumin;Li Cuiui(Department of Nursing,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an Shanxi 710054;Department of Trauma and Orthopedics,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an Shanxi 710054;Department of Joint Surgery,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an Shanxi 710054;Department of Anesthesiology,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an Shanxi 710054;Department of Sports Medicine,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an Shanxi 710054)

机构地区：[1]西安交通大学医学部附属红会医院护理部,陕西西安710054 [2]西安交通大学医学部创伤病医院上肢病区,陕西西安710054 [3]西安交通大学医学部关节病医院膝关节病区,陕西西安710054 [4]西安交通大学医学部麻醉一科,陕西西安710054 [5]西安交通大学医学部运动损伤诊疗中心膝踝病区,陕西西安710054

出　　处：《护士进修杂志》2019年第19期1747-1751,共5页Journal of Nurses Training

基　　金：陕西省西安市科技计划项目[编号:2016050SF/YX06(6)(3)]

摘　　要：目的探讨连续股神经阻滞(CFNB)和连续关节周围组织浸润麻醉(CLIA)及护理对全膝关节置换术后膝关节功能康复的影响。方法选取2017年11-12月西安市红会医院需采取全膝关节置换手术的54例患者为研究对象。采用随机数字表法将患者分为CFNB组(F组,27例)和CLIA组(I组,27例)。均实施围术期疼痛管理。采用视觉模拟评分法评估患者疼痛,记录术后24 h阿片类药物用量及局部麻醉消耗剂量,评估下肢运动神经阻滞评分,测量膝关节活动度(ROM),记录患者不良反应,测评患者满意度。结果两组患者术后静息疼痛、被动运动、主动运动(2 min行试验)比较差异均无统计学意义(P>0.05);I组术后24 h阿片类用量少于F组(P<0.05);两组术后24 h局部麻醉药物消耗剂量差异无统计学意义(P>0.05);I组术后72 h的下肢运动神经阻滞评分明显低于F组(P<0.05);两组术后7 d、1个月关节活动度比较差异有统计学意义(P<0.05);I组患者的满意度优于F组(P<0.05);两组患者均未出现严重的并发症及不良反应。结论CFNB和CLIA组均对全膝关节置换术后镇痛有效,两组镇痛效果差异无统计学意义。但CFNB麻醉患者术后阿片类用药较少,股四头肌肌力及膝关节活动度恢复较CFNB快,有利于TKA患者早期进行功能锻炼和快速康复。Objective To compare the effect of continuous local infiltration analgesia(CLIA) and continuous femoral nerve block(CFNB) on pain,functional recovery,adverse and patient satisfaction effect after total knee arthroplasty(TKA).Methods Fifty-four patients with total knee surgery were divided into 2 group CLIA(I group)and CFNB(F group). Pain was assessed with a visual analog scale(VAS),48 h opioids consumption and 72 h local anesthetic dosage were recorded,motor blockade was assessed,maximum range of motion(ROM) was measured,adverse effect profiles were recorded and patient satisfaction was measured. Results There was no significant difference in postoperative pain between study groups. Group I had less opioid usage in the first 24 h post-operative(P<0.05). No significant difference was found between the groups in the postoperative local anesthetic dosage(P>0.05). Significantly lower scores of Bromage scale in group I in 72 h after surgery(P<0.05) were found. Group I had superior passive maximum ROM in 1 month after surgery and superior active maximum ROM on day 7 and at 1 month after surgery(P<0.05). Group I had better than group F in satisfaction. There was no significant difference in complication and adverse reaction between study groups. Conclusion Both CFNB and CLIA are effective postoperative analgesia methods after TKA. CLIA leads to lower postoperative opioid usage,better quadriceps muscle power and knee function after surgery. It is beneficial to the early functional exercise and early rehabilitation of TKA patients.

关 键 词：全膝关节置换术 镇痛 局部组织浸润麻醉 股神经阻滞 关节功能 疼痛管理 

分 类 号：R473.6[医药卫生—护理学] R684[医药卫生—临床医学]