持续股神经阻滞与患者自控静脉镇痛对人工全膝关节置换术后康复的影响

Effect of continuous femoral nerve block versus patient controlled intravenous analgesia on rehabilitation following total knee arthroplasty

目的 比较持续股神经阻滞（CFNB）与患者自控静脉镇痛（PCIA）对人工全膝关节置换（TKA）术后疼痛控制、康复效果、满意度等方面的影响,以找到一种安全、有效的康复期镇痛方法. 方法 选择因膝关节骨关节炎或类风湿关节炎接受单侧TKA的患者116例,美国麻醉医师协会（ASA）分级1～3级.采用随机数字表法将患者分为CFNB组（58例）和PCIA组（58例）,术后分别给予超声引导下CFNB和PCIA.比较两组术后视觉模拟评分（VAS）、美国特种外科医院（HSS）膝关节功能评分、西安大略及麦克马斯特大学骨关节炎评分（WOMAC）、不良反应发生率及满意度等. 结果 术后4,12h两组VAS差异无统计学意义,术后24,48,72 h CFNB组和PCIA组VAS分别为（3.2±1.1）分：（4.1±1.5）分、（3.4±1.2）分：（4.1±1.0）分、（3.3±1.2）分：（4.0±1.1）分（P均＜0.05）.术后达到直腿抬高、扶拐行走、被动屈膝90°等康复训练目标所需的时间两组差异均无统计学意义.术后3个月HSS膝关节功能评分、WOMAC、手术侧膝关节最大被动屈曲角度差异均无统计学意义.术后恶心、呕吐等不良反应发生率PCIA组（24％）显著高于CFNB组（14％）（P＜0.05）,但两组患者满意度差异无统计学意义. 结论 超声引导的CFNB用于TKA术后早期镇痛,可有效控制疼痛,促进康复训练和功能恢复,降低不良反应发生率,提高患者满意度.

Objective To compare the effect of continuous femoral nerve block （CFNB） with patient controlled intravenous analgesia （PCIA） on pain relief,rehabilitation efficacy,satisfaction degree following total knee arthroplasty （TKA） in an attempt to find a safe and effective analgesia at the stage of rehabilitation.Methods The records of 116 patients undergone unilateral TKA for osteoarthritis or rheumatoid arthritis of the knee were evaluated.The patients with preoperative American Society of Anesthesiology （ASA） score of 1 to 3 were randomized into CFNB group （58 cases） and PCIA group （58 cases） according to the random number table.Both operations were performed under ultrasound guidance.Postoperative visual analogue score （VAS）,knee function,incidence of adverse reaction,and satisfaction degree were compared between the two groups.Results Regardless of the score at postoperative 4 and 12 hours,VAS between CFNB and PCIA groups revealed significant differences at postoperative 24 [（3.2±1.1）pointsvs （4.1 ±1.5）points],48 [（3.4±1.2）pointsvs （4.1 ±1.0） points] and 72 hours [（3.3 ± 1.2） points vs （4.0 ± 1.1） points] （all P 〈 0.05）.Time to achieve knee rehabilitation training objectives like straight leg raise,walking with crutches,and passive bending to 90° were similar between the two groups.Both groups achieved comparable knee function status with respect to Hospital for Special Surgery （HSS） score,Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） score,and maximal knee flexion angle at postoperative 3 months.Postoperative nausea and vomit were significantly more frequent in PCIA group （24%） than in CFNB group （14%） （all P 〈O.05）,but patients in both groups were satisfactory.Conclusion Ultrasound guided CFNB is an effective analgesic method during the early stage of TKA,for it can control pain,accelerate rehabilitation training and function recovery,reduce adverse reaction as well as improve patients＆#39; satisfaction.