两种镇痛方法在膝关节松解术后早期康复治疗中的比较

Comparison of Two Analgesia in Early Rehabilitation on Patients after Knee Arthrolysis

目的 比较连续股神经阻滞和静脉患者自控镇痛泵在膝关节松解术后的镇痛效果及对康复训练的影响.方法 选择拟行单侧膝关节松解术的患者60例,随机分成连续股神经阻滞组（CFNB组,n=30）和静脉镇痛泵组（IPCA组,n=30）.CFNB组在术后实施股神经鞘中留置导管,IPCA组在术后连接静脉镇痛泵.所有患者在术后6h、24h、30h、48h先行被动运动训练,然后行主动运动训练.CFNB组在训练前经留置导管注射0.25%罗哌卡因20ml,IPCA组通过镇痛泵持续静脉输注镇痛药物（舒芬太尼200~250μg和氯胺酮100mg,生理盐水稀释至100ml）.记录康复训练中的视觉模拟评分（VAS）、患肢主动关节屈曲活动度,记录两组副作用的发生情况.结果 CFNB组VAS评分显著低于IPCA组（P〈0.001）,恶心呕吐及皮肤瘙痒的发生率低于IPCA组（P〈0.05）,患肢主动关节活动度显著大于IPCA组（P〈0.001）.结论 应用连续股神经阻滞镇痛效果好,副作用少,是一种理想的用于膝关节松解术后康复训练的镇痛方法.

Objective To compare the effects of continuous femoral nerve block （CFNB） and intravenous patient controlled analgesia （IPCA） on postoperative analgesia and rehabilitation therapy for patients after knee arthrolysis. Methods 60 patients were randomly allocat- ed into CFNB group （n=30） in which patients received CFNB via a catheter inserted in femoral sheath and IPCA group （n=30） in which pa- tients received IPCA via an intravenous infusion pump contained with analgesics. All patients were successively offered passive rehabilita- tion therapy and active rehabilitation therapy at 6, 24, 30, and 48 h post-operation. An injection of 50 mg ropivacaine （0.25%） was adminis- trated via the catheter before rehabilitation therapy in CFNB group. Analgesics （200-250 gg sufentanil and 100 mg ketamine in 100 ml nor- mal saline） were transfused intravenously at a constant rate during the whole postoperative period in group IPCA. Visual Analogue Score （VAS）, active flexion angle （AFA） of suffered knee joint, and side effects related to CFNB or IPCA were recorded. Results The VAS score and the side effect rate were lower in CFNB group than in IPCA group （P〈0.05）. And the AFA was significantly larger in CFNB group than in IPCA group （P〈0.001）. Conclusion CFNB is a safe and beneficial analgesia for patients in postoperative rehabilitation.