连续股神经阻滞镇痛与静脉镇痛用于全膝关节置换术后快速康复的比较

目的比较连续股神经阻滞（continuous femoral nerveblock，CFNB）镇痛与静脉镇痛用于全膝关节置换术（total knee arthroplasty，TKA）后的快速康复效果。方法择期行单侧TKA患者60例，年龄45。78岁，ASA分级I、Ⅱ级，采用随机数字表法分为两组（每组30例）：患者自控神经阻滞镇痛（patient controlled nerve block analgesia，PCNA）组与患者自控静脉镇痛（patient controlled intravenous analgesia，PCIA）组。两组均采用蛛网膜下腔顿膜外腔联合麻醉。观察患者术后静息和运动时VAS评分、患者自控镇痛（patient-contmlled analgesia，PCA）泵按压次数及补救性镇痛药应用次数，观察术后患肢膝关节主动屈曲角度、术后血糖变化、术后平均住院日、并发症、副作用及满意度。结果术后6、12、24、48h静息状态下，两组VAS评分差异无统计学意义（P〉O．05）；与PCIA组比较，PCNA组术后24、48h被动运动时VAS评分降低（3．6±0．5）分比（4．7±0．6）分、（3．4±0．5）分比（4．5±0．4）分]（P〈O．05），PCA泵按压次数及肌内注射哌替啶次数减少（P〈0．05）。与PCIA组比较，PCNA组术后24、48h患肢膝关节主动屈曲角度增大（P〈0．05），术后各时点血糖水平降低（P〈O．05），深静脉血栓形成并发症及嗜睡、呼吸抑制等副作用减少（P〈O．05）；PCNA组术后满意度评分高于PCIA组（9．6±1．4）分比（7．9±1．2）分]（P〈O．05o结论与静脉镇痛比较，CFNB用于TKA术后镇痛效果确切、并发症及副作用少、住院时间缩短、术后恢复快、总体满意度高，符合快速康复外科理念。

Comparison of fast track after total knee replacement surgery with continuous femoral nerve block analgesia and intravenous analgesia

Objective Comparing fast track after total knee arthroplasty (TKA) with continuous femoral nerve block(CFNB) analgesia and intravenous analgesia.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 45-78 years,undergoing unilateral TKA were randomly divided into 2 groups (n=30):patient controlled nerve block analgesia (PCNA) group and patient controlled intravenous analgesia (PCIA) group.All patients received spinal anesthesia combined with epidural anesthesia.In the postoperative period,the VAS in resting and exercise were recorded to evaluate the degree of postoperative pain,the numbers of patient-controlled analgesia (PCA) pressing and meperidine using,muscle strength of limb,the active movement angle,adverse reactions and analgesic associated complications were observed and recorded.Results In 6,12,24,48 h postoperative resting state,there was no significant differences in pain score between CFNB group and PCIA group (P＜0.05).There was significantly less VAS scores in the PCNA group comparing the PCIA group during the continuous passive movement of knee postoperatively at 24 h and 48 h (3.6±0.5) vs (4.7±0.6),(3.4±0.5) vs (4.5±0.4)](P＜0.05).The numbers of PCA pressing and meperidine using of PCNA group were significantly lower than that of PCIA group after surgery (P＜0.05).Angle of knee active movement postoperatively at 24 h and 48 h in the PCNA group was larger than PCIA group (P＜0.05).Blood glucose level of PCNA group was lower than that of PCIA group after surgery (P＜0.05).Postoperative complications such as deep vein thrombosis,adverse reactions such as lethargy,respiratory depression were fewer in the PCNA group(P＜0.05).Patients satisfaction scores in the PCNA group was higher than the PCIA group (9.6±1.4) vs (7.9±1.2)](P＜0.05).Conclusions CFNB has superior early analgesic effect to PCIA in total knee replacement surgery,as well as fewer adverse reactions,better knee function recovery,shorter hospital time and higher patient satisfaction.CFNB is in accordance with fast track surgery concept and it is a safe,practical and effective method for analgesia after TKA.