【作者】 唐帅；

【导师】 黄宇光； 徐仲煌；

【作者基本信息】 中国协和医科大学 ， 麻醉学， 2009， 硕士

【摘要】 目的评价连续股神经阻滞(Continuous Femoral Nerve Block,CFNB)能否降低全膝关节置换术(Total Knee Arthroplasty,TKA)病人的术后疼痛评分,提高病人对康复治疗的配合能力,减轻手术带来的应激反应。方法将32例全麻TKA病人随机分成两组,分别接受静脉病人自控镇痛(IVPatient-controlled Analgesia,PCIA)和CFNB作为术后镇痛方式。记录术中血流动力学和芬太尼用量;病人离PACU时、术后4、8、12、24、48小时的静息和活动VAS评分,吗啡的使用量;术后第一天(Postoperative Day 1,POD1)和第二天(POD2)的CPM角度;采集病人入室,切皮,术毕,POD1,POD2的血样检测白细胞计数、乳酸、血糖、C反应蛋白和皮质醇。结果试验组术中芬太尼用量明显少于对照组(P＜0.05),术后各个时间点试验组的静息和活动疼痛评分均低于对照组(P＜0.05),试验组的吗啡累计消耗量均显著低于对照组(P＜0.05),试验组的嗜睡、恶心呕吐等副作用的发生率是对照组的一半(P＜0.05),试验组术后第一天和第二天的持续被动运动(ContinuousPassive Motion,CPM)角度均大于对照组(P＜0.05),试验组病人对麻醉和术后镇痛的满意度高于对照组(P＜0.05),两组术中及术后各时间点的血糖、乳酸、CRP、皮质醇、白细胞计数均无显著差异。结论在全麻诱导前进行股神经阻滞并留置导管用于术后镇痛可以使术中血流动力学更加平稳,减少术中阿片类药物的用量;显著地降低术后静息和活动疼痛评分,大大降低了术后吗啡消耗量,从而降低了吗啡导致的嗜睡、恶心呕吐等副作用的发生率;使病人更好地耐受术后持续膝关节被动运动,加速了膝关节功能的恢复;提高了病人的满意度。单独连续股神经阻滞对手术引起的应激反应的抑制作用有待于进一步研究。更多还原

【Abstract】 OBJECTIVETo assess the influence of continuous femoral nerve block (CFNB) and IV patient-controlled analgesia (PCIA) on postoperative pain scores, knee rehabilitation and stress response after total knee arthroplasty (TKA).METHODSThe trial was designed as a randomized and controlled study. Before standardized general anesthesia, 32 adult patients scheduled for elective total knee arthroplasty were randomly assigned to CFNB group or PCIA group to receive a different postoperative analgesic technique for 48 hours. Pain was assessed at rest and during continuous passive motion (CPM) using a visual analog scale at PACU and 4, 8,12,24,48 hours postoperatively and morphine consumption was also recorded. The maximal amplitude of knee flexion was measured during CPM in the first postoperative day (POD1) and POD2. As indicators of stress and inflammatory response, changes in the leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein(CRP) and serum cortisol were determined on admission to OR, immediately after skin incision, before extubation, POD1 and POD2, respectively.RESULTSIntraoperative consumption of fentanyl was significantly lower in CFNB group than in PCIA group, (137.5±44.4 ug vs. 264.1±67.1 ug, respectively, P<0.05) . The CFNB group showed significantly lower VAS scores both at rest and during CPM compared with PCIA group at all time points (P<0.05) . Morphine consumption was significantly lower in CFNB group than in PCIA group (P<0.05) . The incidence of side effects such as somnolence, nausea and vomiting in CFNB group was half of that of PCIA group. The CPM amplitude of CFNB group was significantly larger compared with PCIA group on both POD1 and POD2 (P<0.05) . Patient satisfaction was higher in CFNB group than in PCIA group, (93.1±7.9 vs. 79.1±11.9, respectively, P<0.05) . No significant differences were observed between the groups in circulating levels of leukocyte count, serum lactic acid, blood glucose, serum C-reactive protein(CRP) and serum cortisol.CONCLUSIONSIn this study, we determined that, after TKA, CFNB technique provides better pain relief and faster postoperative knee rehabilitation than traditional PCIA. A single CFNB can not attenuate the postoperative stress and inflammatory responses.更多还原