两种镇痛方法对全膝关节置换围置换期应激反应及血管活性物质的影响

Effects of two analgesia methods on the stress response and hemodynamics during total knee arthroplasty

背景:对全膝关节置换患者疼痛的处理一直是临床治疗中关注的重点,寻找安全有效的镇痛方法是外科医生临床研究及工作的重要任务。目的:对比股神经阻滞自控镇痛与自控硬膜外镇痛对全膝关节置换患者围术期应激反应及血流动力学的影响。方法:选择2012年8月到2016年1月在海南医学院第一附属医院进行单侧全膝关节置换的患者60例,根据入院顺序分为观察组与对照组,每组30例。全膝关节置换手术由同一组高年资医生完成,均采用标准的全膝关节置换,对照组采用自控硬膜外镇痛,观察组采用股神经阻滞自控镇痛。观察2组预后、围置换期应激反应及血管活性物质变化情况。结果与结论:(1)观察组术后4,24,48 h的应激目测类比评分均显著低于对照组(P<0.05);(2)观察组术后24,48 h血清5-羟色胺质量浓度均显著低于对照组(P<0.05);(3)2组术前患肢美国膝关节协会评分差异无显著性意义,术后均呈现明显增加的趋势(P<0.05),同时观察组术后1,3个月的美国膝关节协会评分显著高于对照组(P<0.05);(4)观察组术后3个月的呼吸抑制、尿潴留、肺不张、皮肤瘙痒、恶心呕吐等并发症发生情况明显少于对照组(P<0.05);(5)结果提示,相对于自控硬膜外镇痛,股神经阻滞自控镇痛应用于全膝关节置换围手术期能缓解应激疼痛反应,降低5-羟色胺的表达,减少并发症的发生,从而促进患者关节功能的恢复。

BACKGROUND： Pain relief in patients with total knee arthroplasty has always been an important problem, andsearching for a safe and effective analgesic method is an issue of concern.OBJECTIVE： To compare the effects of patient controlled nerve femoral analgesia and patient controlled epiduralanalgesia on the perioperative stress response and hemodynamics in patients with total knee arthroplasty.METHODS： Sixty patients undergoing unilateral total knee arthroplasty admitted in the First Affiliated Hospital of HainanMedical University from August 2012 to January 2016 were selected and equally divided into observation and controlgroups according to the order of admission. The total knee arthroplasty was completed by the senior doctors usingoperation criteria. The patient controlled epidural analgesia analgesia was used in the control group, while theobservation group received the patient controlled nerve femoral analgesia analgesia. The prognosis, perioperative stressresponse and hemodynamic changes were observed.RESULTS AND CONCLUSION： （1） The Visual Analogue Scale scores at postoperative 4, 24 and 48 hours in theobservation group were significantly lower than those in the control group （P 〈 0.05）. （2） The serum level of5-hydroxytryptamine at postoperative 24 and 48 hours in the observation group was significantly lower than that in thecontrol group （P 〈 0.05）. （3） The American Knee Society Knee Score scores at baseline showed no significant differencebetween two groups, and then appeared to be on a significant rise postoperatively （P 〈 0.05）, while the scores atpostoperative 1 and 3 months in the observation group were significantly higher than those in the control group （P 〈 0.05）.（4） The incidence of respiratory depression, urinary retention, atelectasis, skin itching, nausea and vomiting atpostoperative 3 months in the observation group was significantly less than that in the control group （P 〈 0.05）. （5） Theseresults manifest that compared with the patient controlled epidural analgesia, the patient controlled nerve femoralanalgesia in total knee arthroplasty can alleviate the stress response to pain and reduce the expression of5-hydroxytryptamine and the incidence of complications, further promoting the recovery of joint function.