连续股神经阻滞镇痛对老年人全膝关节置换术后早期认知功能的影响

目的：探讨连续股神经阻滞术后镇痛（CFNB）对老年人全膝关节置换术（TKA）后早期认知功能的影响.方法：选择择期行单侧TKA的老年患者60例,随机分为两组（n=30）,分别于术毕接受静脉自控镇痛（PCIA组）和连续股神经阻滞镇痛（CFNB组）,记录术后6h、24h、48 h静息状态和术后24h、48 h持续被动运动训练时VAS疼痛评分、吗啡消耗量以及不良反应（嗜睡、恶心呕吐及瘙痒）的发生率,于术前第1天、术后第1、3、7天对患者采用简易智力状态检查法（MMSE）判断认知功能障碍（POCD）发生率.结果：CFNB组各时间点的静息和被动运动训练时VAS疼痛评分、吗啡消耗量及不良反应发生率均低于PCIA组（P＜0.05）,术后第1天和第3天CFNB组MMSE评分高于PCIA组;POCD发生率低于PCIA组（P＜0.05）,术后第7天两组MMSE评分及POCD发生率无明显差异.结论：TKA后CFNB镇痛能够提供良好的镇痛效果,不良反应发生率低,可以减少吗啡消耗量,降低术后早期POCD的发生率.

Effects of Continuous Femoral Nerve Block Analgesia on Early Stage Cognitive Function of Total Knee Arthroplasty Senior Patients

Objective： To investigate the effects on early stage postoperative cognitive dysfunction of continuous femoral nerve block （CFNB） analgesia （POCD） total knee arthroplasty （TKA） senior pa- tients. Method： Selecting sixty TKA ASA I or I1 patients of both genders, randomly divided into 2 groups （ n = 30 each） femoral nerve block ; accepting patient controlled intravenous analgesia （PCIA group） and continuous analgesia （CFNB group） after surgery respectively. Recording resting state in postoperative 6 h, 24 h, 48 h, VAS pain scale from continuous passive movement training, morphine consumption, and incidence rate of adverse reaction （somnolence, nausea and vomiting and itching）in postoperative 24 h, 48 h. Assessing postoperative cognitive dysfunction （POCD） by using mini-mental state examination （MMSE） the day before operation, and first, third and seventh day after operation. Results： Statistics of resting state, VAS pain scale from continuous passive movement training, mor- phine consumption, and incidence rate of adverse reaction of CFNB group in each time point were low- er than PCIA group. The morphine consumption, and the incidence of somnolence, nausea and vomi- ting and itching were decreased in CFNB group than in PCIA group （ P 〈 O. 05 ）. The MMSE evalua- tion of CFNB group were better than PCIA group, and the incidence rate of postoperative cognitive dys- function （POCD） of CFNB group was lower on first and third postoperative day; MMSE evaluation and incidence rate of POCD exhibited no significant differences on seventh postoperative day. Conclusion： CFNB analgesia can provide a potent analgesia effect with low incidence rate of adverse reactions, re- ducing morphine consumption, and decrease of incidence rate of postoperative early stage POCD.