中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (43): 8027-8030.doi: 10.3969/j.issn.1673-8225.2011.43.012

• 人工假体 artificial prosthesis • 上一篇    下一篇

股神经阻滞在全膝人工关节表面置换围手术期多模式镇痛中的应用

方  锐，邓迎杰，孟庆才，宋玉成   

  1. 新疆维吾尔自治区中医医院，新疆维吾尔自治区乌鲁木齐市830000
  • 收稿日期:2011-06-11 修回日期:2011-09-16 出版日期:2011-10-22 发布日期:2011-10-22
  • 通讯作者: 孟庆才，博士，主任医师，新疆维吾尔自治区中医医院，新疆维吾尔自治区乌鲁木齐市830000
  • 作者简介:方锐☆，男，1974年生，新疆维吾尔自治区乌鲁木齐市人，锡伯族，2007年上海中医药大学毕业，博士，副主任医师，主要从事骨与关节疾病的临床及基础研究工作。 xjfr@163.com

Application of continuous femoral nerve block for perioperative management of pain in total knee arthroplasty

Fang Rui, Deng Ying-jie, Meng Qing-cai, Song Yu-cheng   

  1. Xinjiang Hospital of Traditional Chinese Medicine, Urumqi  830000, Xinjiang Uygur Autonomous Region, China
  • Received:2011-06-11 Revised:2011-09-16 Online:2011-10-22 Published:2011-10-22
  • Contact: Meng Qing-cai, Doctor, Chief physician, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Fang Rui☆, Doctor, Associate chief physician, Xinjiang Hospital of Traditional Chinese Medicine, Urumqi 830000, Xinjiang Uygur Autonomous Region, China xjfr@163.com

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321

被引次数

2

摘要：

背景：股神经阻滞作为一种新兴疼痛控制方式在人工膝关节置换后的应用尚未见广泛开展。
目的：观察股神经阻滞在人工膝关节表面置换围手术期镇痛中的临床疗效。
方法：将接受单侧人工膝关节表面置换的77例患者随机分为治疗组(32例)和对照组(35例)，两组患者均采用多模式镇痛方式，即置换前3 d口服塞来昔布+术中术区局部“鸡尾酒疗法”注射+自控静脉镇痛泵；另外，治疗组患者置换后则于患侧行股神经阻滞。
结果与结论：人工膝关节表面置换后48 h内，治疗组吗啡使用量及相关不良反应明显低于对照组(P < 0.05)；置换后1周内，治疗组患者疼痛目测类比评分与关节活动度改善情况明显优于对照组(P < 0.05)；两组患者置换后3个月HSS评分比较，差别无显著性意义(P > 0.05)。结果显示膝关节表面置换后应用股神经阻滞技术可有效缓解置换后疼痛并促进关节功能早期恢复，同时可降低吗啡用量，从而有效减少相关不良反应的发生。因此，该方法是一种安全有效、镇痛效果满意的镇痛方法。

关键词: 股神经阻滞, 膝关节, 关节置换术, 镇痛, 临床疗效

Abstract:

BACKGROUND: Femoral nerve block as a new pain control after total knee arthroplasty has not been widely carried out.
OBJECTIVE: To observe the clinical efficacy of continuous femoral nerve block for perioperative management of pain in total knee arthroplasty.
METHODS: A total of 77 patients were randomized into study group (32 cases) and control group (35 cases). All patients received a basic analgesic regimen: oral administration of celecoxib preoperatively and injection of cocktail therapy intraoperatively. In addition, the study group received continuous femoral nerve block postoperatively. A morphine patient-controlled analgesia pump was also available as a rescue analgesic to all the patients.
RESULTS AND CONCLUSION: The study group had less pain (P < 0.05) within the first postoperative 48 hours, was more satisfied with the analgesia (P < 0.05) and used less morphine (P < 0.05) compared with the control group. Fewer patients were nauseated, vomited or were drowsy in the study group (P < 0.05). Also, the study group achieved better knee flexion at 1 week after surgery (P < 0.05). However, after 3 months, there were no significant functional differences between the groups (P > 0.05). A continuous femoral nerve block leads to better analgesia, less morphine consumption and less morphine-related side effects after total knee arthroplasty. Early functional recovery is improved. Therefore, the method is a safe and effective analgesia with satisfactory results.

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