股神经阻滞自控镇痛用于全膝置换术后镇痛和功能恢复的疗效观察  

Effects of Self-controlled Analgesia of Femoral Nerve Block on the Analgesia and Functional Recovery after Total Knee Replacement

作　　者：梅高昌[1] 陶清[1] 李元海[2] 张永志 张丁[1] MEI Gao-chang;TAO Qing;LI Yuan-hai;ZHANG Yong-zhi;ZHANG Ding(Department of Anesthesiology,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei,Anhui,230031,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui,230022,China)

机构地区：[1]安徽中医药大学第一附属医院麻醉科,安徽合肥230031 [2]安徽医科大学第一附属医院麻醉科,安徽合肥230022

出　　处：《现代生物医学进展》2020年第10期1877-1880,共4页Progress in Modern Biomedicine

基　　金：安徽省2017年公益性技术应用研究联动计划项目(1704f0804021)。

摘　　要：目的:观察股神经阻滞自控镇痛用于全膝置换(total knee arthoplasty,TKA)术后镇痛和功能恢复的疗效。方法:选择2017年8月~2019年6月院骨科收治的膝关节骨性关节炎患者122例,根据随机数字表法将其分为观察组与对照组,每组61例患者。所有患者均采用静吸复合全身麻醉,观察组给予股神经阻滞自控镇痛,对照组给予静脉自控镇痛,记录和比较两组患者术后镇痛效果与功能恢复情况。结果:观察组术后1 d、3 d与7 d的疼痛视觉模拟评分法(Visual Analogue Scale/Score,VAS)评分、血清白细胞介素(Interleukin,IL)-6和C-反应蛋白(C-reactive protein,CRP)含量都显著低于对照组(P<0.05),患肢膝关节活动度明显高于对照组(P<0.05),术后7 d的恶心、头晕、嗜睡、心动过缓等并发症发生率(4.9%)显著低于对照组(21.3%,P<0.05),术后1 d、1个月与3个月的患肢膝关节活动度显著高于对照组(P<0.05)。结论:股神经阻滞自控镇痛用于TKA可提高术后镇痛效果,促进膝关节功能恢复,减少术后并发症的发生,可能与其有效抑制IL-6和CRP的释放有关。Objective: To investigate the effects of self-controlled analgesia of femoral nerve block on analgesia and functional recovery after TKA. Methods: From August 2017 to June 2019, 122 cases of patients with knee osteoarthritis admitted to the orthopedic department of a certain hospital were randomly divided into observation group(61 cases) and control group(61 cases). All patients were underwent general anesthesia with static inhalation, and the observation group were received self-controlled analgesia of the femoral nerve block, the control group were received intravenous analgesia, recorded the postoperative analgesic effects and functional recovery.Results: The pain VAS of the observation group were significantly lower than that of the control group at 1 d, 3 d and 7 d after operation(P<0.05), and the serum IL-6 and CRP levels were significantly lower than the control group(P<0.05), the activity rate were significantly higher than that of the control group(P<0.05). The incidence of complication, such as nausea, dizziness, lethargy, and bradycardia on the 7 d after operation were 4.9 %, which were significantly lower than that of the control group(21.3 %)(P<0.05). The knee joint mobility in the observation group at 1 d, 1 month and 3 months after operation were significantly higher than that in the control group(P<0.05). Conclusion: The application of self-controlled analgesia of femoral nerve block in TKA can inhibit the release of inflammatory factors, improve the postoperative analgesic effect, promote the recovery of knee joint function, and reduce the occurrence of postoperative complications.

关 键 词：股神经阻滞自控镇痛 全膝置换 静脉自控镇痛 膝关节功能 炎症因子 

分 类 号：R687[医药卫生—骨科学] R614[医药卫生—外科学]