鸡尾酒疗法和股神经阻滞麻醉在全膝关节置换术中的疗效对比

Comparison of Cocktail Therapy and Femoral Nerve Block Anesthesia in Total Knee Arthroplasty

目的比较鸡尾酒疗法和股神经阻滞麻醉在全膝关节置换术(TKH)中的疗效。方法回顾性分析2017年6月至2019年6月成都医学院第一附属医院骨科TKH患者76例,根据术前镇痛方式不同分成两组,鸡尾酒组(n=41)术中加用鸡尾酒疗法辅助术后镇痛,股神经阻滞组(n=35)术中加用股神经阻滞麻醉。观察并记录术前膝关节美国特种外科医院(HSS)评分、内外翻角度和术后1、3、7 d患者视觉模拟疼痛评分(VAS)、术后半年膝关节HSS评分,复查术后影像学资料,并对各组数据进行统计学分析。结果1)两组患者性别、年龄、体重指数(BMI)、术前膝关节屈伸度、初次膝关节置换侧、术后因急性疼痛使用曲马多人数相比,差异无统计学意义(P>0.05);2)两组患者分别比较术后1、3、7 d的VAS评分比较,F时点差异有统计学意义(P<0.05),F时点×组别差异无统计学意义(P>0.05);同组患者膝关节术前、术后半年HSS评分比较,差异有统计学意义(P<0.05);两组患者术前HSS评分比较,差异无统计学意义(P>0.05);两组患者术后半年HSS评分比较,差异无统计学意义(P>0.05)。结论两种镇痛方式均可一定程度帮助缓解TKH术后疼痛,提高膝关节HSS评分,改善膝关节功能,但股神经阻滞麻醉的镇痛效果优于鸡尾酒疗法。

Objective To compare the efficacy of cocktail therapy and femoral nerve block anesthesia in total knee arthroplasty(TKH).Methods A total of 76 patients undergoing TKH in the Department of Orthopedics,the First Affiliated Hospital of Chengdu Medical College from June 2017 to June 2019 were retrospectively analyzed.They were divided into two groups according to the different analgesia methods.In the cocktail group(n=41),postoperative analgesia was assisted by cocktail therapy during surgery,while in the group of femoral nerve block(n=35),femoral nerve block anesthesia was added during surgery.The preoperative knee joint American Hospital for Special Surgery(HSS)score,varus and valgus angle,visual analogue pain score(VAS)at 1,3,and 7 d after surgery,and knee joint HSS score at half a year after surgery were observed and recorded.The postoperative imaging data were reviewed.And the data of each group were statistically analyzed.Results There was no statistically significant difference in gender,age,body mass index(BMI),preoperative knee flexion and extension,the side of first knee arthroplasty,and the number of patients using tramadol for acute pain after surgery between the two groups(P>0.05).As for the VAS scores at 1,3,and 7 d after surgery,there was significant difference between the two groups in Ft(P<0.05),while there was no significant difference in Ft×g between the two groups(P>0.05).The knee joint HSS scores of the two groups before operation were significantly different from those half a year after surgery(P<0.05).However,there was no significant difference in preoperative HSS score between the two groups(P>0.05),and there was no significant difference in HSS score between the two groups half a year after surgery(P>0.05).Conclusion Both of the two analgesic methods can help relieve pain after TKH to a certain extent,improve knee joint HSS score,and improve knee joint function.And the analgesic effect of femoral nerve block anesthesia is better than that of cocktail therapy.