收肌管阻滞联合静脉自控镇痛对全膝关节置换术患者术后抑郁状态的影响

Effect of adductor canal block combined with intravenous patient⁃controlled analgesia on postoperative depression in patients undergoing total knee arthroplasty

目的 探讨收肌管阻滞(ACB)联合静脉自控镇痛(PCIA)对行全膝关节置换术患者术后抑郁状态的影响。方法选择行全膝关节置换术的患者随机分为ACB联合PCIA组(A组)40例和PCIA组(B组)40例。B组术后给予PCIA镇痛方法,A组在B组基础上术前联合ACB镇痛。记录术后2 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、72 h(T_(5))静息和运动VAS评分,术后补救镇痛药物使用情况,恶心呕吐发生情况,术前、术后1 d、术后3 d医院焦虑抑郁量表(HADS)评分。结果A组患者T1~T4时静息和运动VAS评分明显低于B组(P<0.05);A组患者术后补救镇痛药物使用量明显减少(P<0.05),恶心呕吐发生率明显降低(P<0.05);A组患者术后1 d HADS评分及术后出现显著的抑郁症状(HADS-D≥8)的患者比例明显低于B组(P<0.05);术后1 d HADS评分与T1~T4时静息和运动VAS评分呈明显正相关(P<0.05);术后3 d HADS评分与T_(1)~T_(3)时静息和运动VAS评分呈明显正相关(P<0.05)。结论ACB联合PCIA相比单纯PCIA在全膝关节置换术后镇痛效果更加显著,并可减少术后抑郁的发生,促进患者快速康复。

Objective To investigate the effect of adductor canal block(ACB)combined with patient⁃con⁃trolled intravenous analgesia(PCIA)on postoperative depression in patients undergoing total knee arthroplasty.Methods Eighty patients undergoing total knee replacement were randomly divided into ACB plus PCIA group(Group A)and PCIA group(group B),with 40 cases in each group.Group B were given PCIA after operation,while group A was given ACB before operation additionally.The Visual Analogue Scale(VAS)score at resting and during movement were recorded at 2 h(T_(1)),6 h(T_(2)),12 h(T_(3)),24 h(T_(4)),72 h(T_(5))after operation.The use of remedial analgesics after operation and the incidence of nausea and vomiting were recorded.The hospital anxiety and depression scale(HADS)score was recorded before operation,1 day and 3 days after operation.Results The VAS scores at resting and during movement from T1 to T4 in group A were significantly lower than those in group B(P<0.05).In group A,the use of remedial analgesics and the incidence of nausea and vomiting after operation were significantly reduced(P<0.05).In group A,the HADS score 1 day after operation and the propor⁃tion of patients with significant depressive symptoms(HADS⁃D≥8)were significantly lower than those in group B(P<0.05).There was significant positive correlation between HADS score 1 day after operation and VAS score at resting and during movement from T_(1) to T_(4)(P<0.05).There was significant positive correlation between HADS score 3 days after operation and VAS score at resting and during movement from T_(1) to T_(3)(P<0.05).Conclusion ACB combined with PCIA is more effective than PCIA alone after total knee arthroplasty,and can reduce the occur⁃rence of adverse emotions and promote rapid recovery of patients.