连续股神经阻滞镇痛对膝关节置换术后局部炎症反应的影响

目的：探讨连续股神经阻滞（CFNB）对人工全膝关节置换术（TKA）后局部炎症反应的影响.方法：全麻下行单膝关节置换术的老年患者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）;术后6、12、24及48 h采集引流管内引流液2 mL,检测白细胞介素6（IL-6）、白细胞介素8（IL-8）和前列腺素E2（PGE2）浓度,记录术后6、12、24及48 h静息状态和术后24 h、48 h持续被动运动时VAS疼痛评分,并各时间点的吗啡消耗量以及持续被动运动（CPM）角度.结果：术后6、12、24和48 h的IL-6、IL-8、PGE2浓度CFNB组低于PCIA组,差异具有统计学意义（P＜0.05）;术后24 h、48 h被动运动VAS疼痛评分CFNB组低于PCIA组,差异有统计学意义（P＜0.05）;术后6、12、24和48 h吗啡消耗量CFNB组低于PCIA组,差异具有统计学意义（P＜0.05）;CPM角度CFNB组大于PCIA组,差异具有统计学意义（P＜0.05）.结论：CFNB可以减轻TKA后膝关节局部的炎症反应,有利于术后镇痛及早期功能锻炼.

Effects of Continuous Femoral Nerve Block Analgesia on Local Inflammation in Elderly Patients after Accepting Knee Arthroplasty

Objective： To investigate the continuous femoral nerve block （CFNB） analgesia on local inflammation in elderly patients after accepting knee arthroplasty （TKA）. Method： Sixty patients ac- cepting total knee arthroplasty were randomly divided into patient controlled intravenous analgesia （PCIA） group and CFNB group with 30 cases in each. Drainage samples were collected for determina- tion of interleukin 6 （ IL-6）, intedeukin 8 （ IL-8 ） and postaglandin E2 （ PGE2 ） concentrations in 6 h, 12 h, 24 h, 48 h after operation. VAS pain scores in resting state in 6 h, 24 h, 48 h after operation and in continuous passive movement （CPM） state in 24 h, 48 h after operation, morphine consump- tion, and the angle of the CPM were recorded. Results： The concentrations of IL-6, IL-8 and PGE2 were decreased in CFNB group as compared with PCIA group in 6 h, 12 h, 24 h, 48 h after operation （ P 〈 0.05 ）. The VAS scores in CPM state and morphine consumption in CFNB group were lower than those in PCIA group （P 〈 0.05）. The angle of the CPM was bigger in CFNB group than that in PCIA group. Conclusions： CFNB analgesia can relieve local inflammation of the knee and provide good an- algesia and early function exercise in elderly patients after TKA.