连续股神经阻滞用于老年全膝置换术患者术后自控镇痛的临床观察

Observation on pain control with continuous femoral nerve block after knee replacement surgery in old patients

目的 探讨患者自控连续股神经镇痛用于老年全膝置换术的可行性.方法 单侧全膝关节置换术患者40例随机分为两组：患者自控连续股神经镇痛组（F组）与患者自控连续硬膜外镇痛组（E组）,每组各20例.腰麻联合硬膜外阻滞下手术.F组在手术结束后行股神经穿刺,术后行自控镇痛.两组镇痛泵的配方如下：F组为罗哌卡因600 mg加生理盐水稀释至300 ml,输注速度为6 ml/h;E组为罗哌卡因225 mg,稀释至100 ml,输注速度为2 ml/h.观察术后各时间点血液动力学变化、VAS评分以及不良反应的发生率.结果 术后两组患者疼痛评分无统计学差异,E组术后血液动力学波动较明显且不良反应的发生率较高（P〈0.05）.结论 股神经阻滞用于术后患者自控镇痛对于老年全膝置换术患者能提供有效的镇痛效果,且可以显著提高患者的安全性,减少不良反应.

Objective To investigate the possibility of patient-controlled analgesia with continuous femoral nerve block for knee replacement surgery. Methods Forty patients undergoing one knee joint replacement operation , were divided randomly into two groups with twenty patiensts in each, group F： patient-controlled femoral nerve analgesia （PCFA）; group E： patient-controlled epidural analgesia （PCEA）. All operations were operated under subarachnoid block combined with epidural anesthesia. After operation, femoral nerve blockade was operated and then an analgesia pump was connected to the catheter in F group. The anesthetic mixture used in the two groups was as following： ropivacaine 600mg was diluted with NS to 300ml in group F and infused by 6ml/h; In group E, ropivacaine 225mg was diluted with NS to 100ml and infused by 2 ml/h. The change of hemodynamics, VAS, as well as the incidences of adverse reactions at different time points were observed. Results There was no statistical difference between the two groups in VAS（P〉0.05）. But in group E,the fluctuation of hemodynamics was more obvious and the incidences of adverse reactions were higher than that in group F（P〈0.05）. Conclusion PCFA can provide an effective analgesic for olderly patients undergoing one knee joint replacement operation,improve patients＇ safety and reduce the incidence rate of adverse reactions.