股神经联合坐骨神经阻滞镇痛对膝关节置换术后深静脉血栓形成原因的影响

Effects of postoperative analgesia with femoral nerve combined with sciatic nerve blocks on the causes of deep venous thrombosis in patients with total knee joint replacement

目的 探讨股神经联合坐骨神经阻滞镇痛对膝关节置换术后深静脉血栓形成原因的影响.方法 连续硬膜外联合腰麻下行膝关节置换手术患者50例,随机分为阻滞镇痛组和药物镇痛组.阻滞镇痛组术后给予持续股神经联合坐骨神经阻滞术后镇痛.药物镇痛组术后按需给予哌替啶肌注.监测术后两组股静脉血流量（BF）、VAS评分及出血凝血功能.结果 两组患者BF术后各时点与术前差异均有统计学意义（P＜0.05）;与药物镇痛组比较,阻滞镇痛组术后1～6 d时BF均较高（P＜0.05）.与术前比较,药物镇痛组术后1～6 d时VAS评分升高;阻滞镇痛组术后3～6 d时VAS评分均升高（P＜0.05）.与药物镇痛组比较,阻滞镇痛组术后1～4 d时VAS均较低（P＜0.05）.与术前比较,术后两组患者血浆D-二聚体均升高（P＜0.05）;与药物镇痛组比较,阻滞镇痛组术后血浆D-二聚体较低（P＜0.05）.结论 膝关节置换术后股神经联合坐骨神经阻滞术后镇痛,患者下肢股静脉血流增多,降低D-二聚体的升高,有利于防治下肢静脉血栓形成.

Objective To explore the effects of postoperative analgesia with femoral nerve combined with sciatic nerve blocks on the causes of low limb deep vein thrombosis after knee joint replacement. Methods Fifty patients with knee joint replacement under spinal combined with epidural anesthesia were randomly divided into block analgesia group and drug analgesia group. The patients in the block analgesia group received continuous femoral nerve combined with sciatic nerve block anal- gesia postoperatively. The drug analgesia group received pethidine intramuscularly on demand. Femoral venous blood flow, VA5 and the bleeding and clotting function were determined after the operation. Results There were significant differences in BF between pre-treatment and each time points after the treatment in two groups （P〈0. 05） ; Compared with drug analgesia group, BF was significantly increased at 1-6 d after the treatment in block analgesia group（P〈0.05）. Compared with pre-treatment, VAS was significantly increased at 1-6 d after the treatment in drug analgesia group, while increased at 3-6 d after the treatment in block analgesia group（P〈0. 05）. VAS was lower at 1-4 d after the treatment in block analgesia group than that in drug analgesia group（P〈0.05）. Compared with pre-treatment, D-direct was significantly increased after the treatment in two groups （P〈0.05）; D-dimer was significantly lower in block analgesia group than that in drug analgesia group（P〈0.05）. Conclusion Blood flow in femoral vein is increased and the increase of D-dimer is decreased during postoperative analgesia with femoral nerve combined with sciatic nerve blocks in pa- tients with knee joint replacement, which are in favor of preventing the lower limb venous thrombosis.