股神经阻滞用于膝关节术后镇痛.docVIP

连续股神经阻滞用于全膝关节置换术后康复镇痛的临床观察 南兴东 北京大学第三医院麻醉科，北京100083 摘要　目的:观察连续股神经阻滞用于全膝关节置换术后康复镇痛的效果。方法:选择ASAⅠ～ Ⅱ级行单侧全膝关节置换患者30例,随机分为2组:股神经阻滞组(FA,n=15) 和持续静脉镇痛组（IA，n=15）。所有患者均实施气管插管全身麻醉。FA组患者术后通过留置导管间断注射0. 5 % 盐酸利多卡因镇痛，IA组患者术后静脉持续输注曲马多镇痛，两组患者均维持镇痛3天。记录静息、主动和持续被动功能训练时的VAS疼痛评分,开始下床活动时间，镇静程度，肌力分级和并发症发生率。结果:FA 组患者在术后6 h、24 h、48 h及72h的静息、主动和持续被动功能训练时的VAS疼痛评分均明显低于IA 组患者（P 0. 05或P 0. 01）；两组患者下床活动时间无显著性差异[（25±2）h vs（27±4）h, P ＞ 0. 05]；两组患者镇静程度总体较满意；两组患者的术后24h～72h肌力评分平均大于3级；与IA 组比较，FA组患者并发症发生率明显减少，差异具有显著统计学意义（4 vs 12,P＝0.009）。结论: 连续股神经阻滞镇痛效果良好,对下肢肌力影响轻微，并发症发生率低，是TKA术后较为理想的康复镇痛方法。 关键词　全膝置换；术后镇痛；股神经阻滞 Clinical Observation of Continuous Femoral Nerve Blockade for Postoperative Rehabilitation Pain After Total Knee Arthroplasty Surgery NAN Xing-dong, JIA Dong-lin, ZHANG Li-ping, etal. Department of Anesthesiology, Peking University Third Hospital, Beijing 100083, China. Abstract 　Objective To observe the effect of continuous femoral nerve on postoperative rehabilitation pain after total knee arthroplasty(TKA) surgery. Methods Thirty patients , ASA I~II , undergoing unilateral TKA surgery , were randomly divided into two groups : group FA and group IA. All patients received general anesthesia with tracheal intubation. After operation patients were given nerve-bolcked analgesia with 0.5 % Hydrochloric acid Lidocaine injected through a catheter in Group FA (15ml, 2~6 h/prn) and continuous intravenous analgesia with tramadol in group IA. All patients were maintained analgesia for 3 days. VAS Pain scores during rest, initiative exercise and continuous passive movement (CPM), time of first walk, Rameasay sedation scores, muscle’ st rength grades and complications were recorded. Results The VAS pain scores during rest, initiative exercise and CPM at all timepoints except postoperative 1h in group FA were obvious lower than those in group IA. There weren’t significant difference about the time of first walk between two groups[(27±4）h vs（25±2）h] . In general ,it was satisfactory about sedation degre