连续股神经阻滞复合局部浸润麻醉对老年患者全膝关节置换手术术后的镇痛效果和应激反应的影响

Clinical Investigation of Influence on Postoperative Analgesia and Perioperative Stress Response

目的探讨连续股神经阻滞复合局部浸润麻醉对全膝关节置换手术术后的镇痛效果和应激反应的影响。方法择期行单侧全膝关节置换手术的老年患者64例,用数字随机表均分为2组:超声引导下行连续股神经阻滞镇痛组(A组)和连续股神经阻滞复合局部浸润麻醉组(B组);术中均采用全凭静脉麻醉。记录术毕12h、术毕1d、术毕2d、术毕3d、术毕5d静息时VAS评分和持续被动运动VAS评分;记录术前、术毕1d、术毕2d、术毕3d、术毕5d白细胞计数、血糖、C-反应蛋白(CRP)变化;记录患者术后镇痛满意率、术后额外镇痛药使用情况及不良反应发生情况。结果与A组比较,B组在术毕12h、术毕1d、术毕2d静息时VAS评分和运动VAS评分明显减低,组间比较差异无统计学意义(P<0.05);术毕3d、术毕5d静息和运动VAS评分B组小于A组,但组间比较差异无统计学意义。与术前比较,两组患者C-反应蛋白(CRP)在术后1d均有升高,在术后3d达到峰值,术后5d回落到术前水平;与A组比较,B组C-反应蛋白(CRP)在术后1d低于A组,组间比较差异有统计学意义(P<0.05)。两组间白细胞计数、血糖水平比较差异无统计学意义。A组额外镇痛药使用次数(1.8±0.8)次高于B组(0.6±0.7)次(P<0.05)。A组患者满意率为24例(75%)低于B组的31例(96.88%),组间比较差异有统计学意义(P<0.05)。两组术后不良反应组间比较差异无统计学意义。结论连续股神经阻滞复合局部浸润麻醉对老年患者全膝关节置换手术术后具有很好的镇痛效果,减轻术后疼痛应激反应,不良反应少。

Objective To investigate the effect of continuous femoral nerve blockade combined with local anesthesia,on postoperative analgesia and perioperative stress response after total knee arthroplasty. Methods Sixty-four elderly patients undergoing elective unilateral total knee arthroplasty were randomized to receive either ultrasound-guided continuous femoral nerve block analgesia（ group A） or continuous femoral nerve blockade combined with local anesthesia（ group B）. Total intravenous anesthesia were used in both operations. VAS scores were recorded at rest and continuous passive motion 12 h,1d,2d,3d and 5d after surgery. Changes of white blood cell count,blood glucose,C- reactive protein（ CRP） were also recorded. Rate of satisfaction with postoperative analgesia,additional usage of postoperative analgesic and adverse events were recorded as well. Results VAS scores at rest and continuous passive motion 12 h,1d and 2d after surgery significantly decreased more in B group（ P〈0. 05） between the two groups. However,B group had a lower VAS scores at rest and continuous passive motion 3d and 5d after surgery with no significant difference between groups. Compared with pre-operation,C- reactive protein（ CRP） of both two increased 1 day later,reached the peak 3 days later,and fell to preoperative levels 5 days later; Compared with group A,C- reactive protein（ CRP） of group B 1 day after surgery was lower（ P〈0. 05） between the two groups. White blood cell count and blood glucose levels between the two groups showed no significant difference. Group A had a higher frequency of usage of additional analgesic（ 1. 8 ± 0. 8） than group B（ 0. 6 ±0. 7）（ P 0. 05）. Rate of satisfaction in group A was 24 cases（ 75%）,which was lower than that in group B（ 31 cases（ 96. 88%））,and there are significant differences（ P〈0. 05） between the two groups. Adverse reactions between the two groups showed no statistically significant. Conclusions Continuous femoral nerve block combined with local anesthesia after total knee replacement surgery in elderly patients had a good analgesic effect and reduced postoperative stress response,with fewer adverse reactions.