连续股神经阻滞镇痛对老年TKA患者镇痛效果及术后早期认知功能障碍的影响

Effects of continuous femoral nerve block on postoperative analgesia and early cognitive dysfunction in elderly patients with total knee arthroplasty

目的探讨连续股神经阻滞镇痛对老年全膝关节置换术(TKA)患者镇痛效果及术后早期认知功能障碍(POCD)的影响。方法选取山东省曹县县立医院2015-01/2017-01期间行全膝关节置换术老年患者90例,年龄≥60岁,ASA分级Ⅰ~Ⅱ级,根据随机数字表法,将患者随机分为观察组(n=45)和对照组(n=45),分别于TKA术后采用连续股神经阻滞镇痛和静脉自控镇痛,最后观察2组术后VAS疼痛评分、吗啡用量、不良反应的发生率,以及采用简易智力状态量表(MMSE)对患者术后早期认知功能障碍(POCD)进行评估,记录每组的POCD发生率。结果观察组患者TKA术后不同时间点的VAS评分、吗啡用量、不良反应(呕吐、恶心,嗜睡及瘙痒)的发生率均明显低于对照组,组间比较差异具有统计学意义(P<0.05);术后1 d及3 d,观察组患者MMSE评分明显高于对照组,而POCD发生率明显低于对照组,组间比较差异具有统计学意义(P<0.05),观察组术后48 h内镇痛泵的有效按压次数与总次数均低于对照组(P<0.05)。结论连续股神经阻滞镇痛对老年TKA术后患者镇痛效果好,不良反应少,能明显减少吗啡的用量,并降低POCD的发生率。

Objective To investigate the clinical effects of continuous femoral nerve block on postoperative analgesia and early postoperative cognitive dysfunction in elderly patients with total knee arthroplasty(TKA).Methods Ninety elderly patients undergoing total knee arthroplasty were selected from Cao County Hospital of Shandong Province from January2015to January2017.All patients were≥60years old and were classified as ASA gradeⅠ-Ⅱ.According to the random number table method,the patients were randomly divided into the control group receiving patient-controlled intravenous analgesia(PCA)and the observation group receiving PCA plus continuous femoral nerve block postoperatively.Parameters recorded included postoperative VAS pain scores,morphine consumption,incidence of adverse events,and rate of postoperative early cognitive dysfunction(POCD)evaluated by the Mini-Mental Status Scale(MMSE).Results The VAS scores,total morphine dosage,incidence of adverse events(vomiting,nausea,drowsiness and pruritus)in observation group were significantly decreased when compared with control group at different time points after TKA(P<0.05);MMSE scores of observation group were significantly higher than those of control group on the postoperative day1and3,while the incidence of POCD in the observation group was significantly lower than that of the control group(P<0.05).The total number of demands and bolus dose delivered by PCA pump in observation group were significantly lower than those in control group(P<0.05)for the first48hours.Conclusion Continuous femoral nerve block in elderly TKA patients provided better postoperative pain control than PCA alone,with significantly less morphine consumption,less adverse events and lower incidence of POCD.