超声引导下神经阻滞对全膝关节置换术后患者镇痛效果分析

Analgesic Effect Analysis of Ultrasound-guided Nerve Block on Patients after the Total Knee Replacement

目的对比分析超声引导下持续股神经阻滞对全膝关节置换术后患者的镇痛效果。方法按照随机数表法将2017年2月至2018年2月黔南州中医医院收治的60例行单侧全膝关节置换术治疗的患者分为观察组(30例)和对照组(30例),其中观察组患者于全膝关节置换术后在超声引导下行持续股神经阻滞镇痛,对照组患者于全膝关节置换术后行静脉镇痛,对比两组患者术后4、 8、 12、 24、 48 h静息状态下及术后24、 48、 72 h持续被动功能锻炼时的视觉模拟评分(visual analogue scale, VAS),术后2、 3、 4、 5、 6 d股四头肌的肌力评分、术后2、 3、 4、 5、 6 d的膝关节最大被动屈伸活动度以及术后不良反应发生率。结果术后4、 8、 12、 24、 48 h静息状态下及术后24、 48、 72 h持续被动功能锻炼时,观察组患者VAS评分均明显低于对照组,P均<0.01,差异具有统计学意义;术后2、 3、 4、 5、 6 d,观察组患者股四头肌肌力评分与对照组患者无明显差异,P均>0.05,差异无统计学意义;术后2、 3、 4 d,观察组患者膝关节最大被动屈伸活动度明显高于对照组,P均<0.01,差异具有统计学意义,而术后5、 6 d,观察组患者膝关节最大被动屈伸活动度与对照组无明显差异,P均> 0.05,差异无统计学意义;治疗过程中,观察组患者不良反应发生率为3.33%,明显低于对照组患者的不良反应发生率40.00%,P<0.01,差异具有统计学意义。结论超声引导下持续股神经阻滞可有效降低全膝关节置换术后患者的疼痛程度,镇痛效果显著,且不良反应发生率较低,对肌力无影响,有利于患者的早期功能恢复。

Objective To analyze the analgesic effect of ultrasound-guided constant femoral nerve block on patients after the total knee replacement.Methods Sixty patients who underwent unilateral total knee replacement between February 2017 and February 2018 in Qiannan Prefecture Hospital of Chinese Medicine were divided into an observation group(30 patients) and a control group(30 patients) according to the random number table. In the observation group after the operation the patients were given ultrasound-guided constant femoral nerve block to relieve pain, while in the control group the patients were given intravenous analgesia after the operation. The visual analogue scale(VAS) tested at postoper-ative 4 h, 8 h, 12 h, 24 h and 48 h at the resting state and at postoperative 24 h, 48 h and 72 h during the continuous passive functional exercise, and the muscle strength score of quadriceps femoris, the maximum movement degree of knee passive flexion and extension, and the postoperative incidence of adverse reactions on postoperative day 2, 3, 4, 5 and 6, were compared between the two groups.Results In the observation group, the VAS scores of patients at postoperative 4 h, 8 h,12 h, 24 h and 48 h at the resting state and at postoperative 24 h, 48 h and 72 h during the continuous passive functional exercise were all markedly lower than that in the control group, and the differences were statistically significant, allP<0. 01. No statistically significant differences were observed when the muscle strength scores of quadriceps femoris on postoperative day 2, 3, 4, 5 and 6 were respectively compared between the two groups, and allP> 0. 05. On postoperative day 2,3 and 4, the maximum movement degrees of knee passive flexion and extension in the observation group were statistically higher than that in the control group, and allP< 0. 01. However, on postoperative day 5 and 6, there was no statistically significant difference between the maximum movement degrees of knee passive flexion and extension in the two groups, both P> 0. 05. During the treatment course, the incidence of adverse reactions in the observation group was 3. 33%, which was significantly lower than 40. 00% in the control group, and a statistical difference was observed,P< 0. 01.Conclusion Ultrasound-guided constant femoral nerve block can effectively alleviate patients’ pain following the total knee replacement,presenting marked analgesic effect. And besides, with lower incidence of adverse reactions, this analgesic method exerts no effect on muscle strength, favoring the early functional recovery of patients.