连续股神经阻滞镇痛对全膝关节置换(TKA)术后疼痛及早期膝关节功能康复的研究李德毅张旭刘川吴继生(四川省巴屮市屮心医院骨科636000)【摘要】R的：比较比较连续股神经阻滞(CFNB)和持续静脉镇痛(CIA)对全膝关节置换(TKA)术后疼痛及早期膝关节功能康复的影响。方法：将2012年1月〜2013年12月于我院初次行单侧全膝关节置换的22例患者随机分为比较连续股神经阻滞组(n=ll例)和持续静脉镇痛组(n=ll例)。观察和比较两组患者术后视觉模拟评分VAS、CPM度数、被动屈伸活动度、术后CRP水平及术后下肢深静脉血栓形成情况。结果：术后第1、2、3、4天，连续股神经阻滞组VAS评分(5.06&plusmn;0.23、4.78&plusmn;0.12、3.04&plusmn;0.52、2.676&plusmn;0.71)明显低于持续静脉镇痛组(7.32&plusmn;0.76、6.84&plusmn;0.91、5.90&plusmn;0.78、3.46&plusmn;0.85)，差异均有统计学意义(P<0.05)；术后第2、3、4、5天,连续股神经阻滞组CPM锻炼度数(68.34&plusmn;4.66、74.06&plusmn;5.31、82.63&plusmn;3.84、86.56&plusmn;4.78)明显高于持续静脉镇痛组(44.82&plusmn;4.32、50.04&plusmn;6.19、56.52&plusmn;4.66、63.06&plusmn;3.73)，差异均有统计学意义(P<0.05);两组患者术后膝关节被动活动度比较无统计学差异;连续股神经阻滞组术后患者血清CRP水平低于持续静脉镇痛组，均在术后第4天达到峰值,但组间比较均无统计学差异(P&gt；0.05)；两组患者术后双下肢深静脉血栓形成情况比较无统计学差异。结论：连续股神经阻滞能够更加有效地降低全膝关节置换患者术后的疼痛评分，术后镇痛效果更为明显，更加有效地促进患者早期膝关节功能康复。【关键词】膝关节置换;镇痛;术后【中图分类号】R614【文献标识码】A【文章编号】2095-1752(2015)23-0050-03[Abstract]ObjectiveTocomparetheeffectofcontinuousfemoralnerveblock(CFNB)andcontinuousintravenousanalgesia(CIA)onpostoperativepainandrehabilitationofearlykneejointfunctionaftertotalkneearthroplasty(TKA).Method22patientswererandomlydividedintocomparisoncontinuousfemoralnerveblockgroup(n=11patients)andcontinuousintravenousanalgesiagroup(n=11cases),whowereperformedprimaryunilateraltotalkneearthroplastyinourhospitalfromJanuary2012toDecember2013.ObserveandcomparepostoperativevisualanalogscaleVAS,CPMdegree,passiverangeofmotion,postoperativeCRPlevelsandpostoperativedeepvenousthrombosisofthetwogroups.Results1,2,3,4daysaftertheoperation,VASscoresofcontinuousfemoralnerveblockgroup(5.06&plusmn;0.23,4.78&plusmn;0.12,3.04&plusmn;0.52,2.676&plusmn;0.71)weresignificantlylowerthanthatofcontinuousintravenousanalgesiagroup(7.32&plusmn;0.76,6.84&plusmn;0.91,5.90&plusmn;0.78,3.46&plusmn;0.85),thedifferencewasstatisticallysignificant(P<0.05).2,3,4,5daysaftertheoperation,CPMexercisedegreesofcontinuousfemoralnerveblockgroup(68.34&plusmn;4.66,74.06&plusmn;5.31,82.63&plusmn;3.84,86.56&plusmn;4.78)weresignificantlyhigherthanthatofcontinuousintravenousanalgesiagroup(44.82&plusmn;4.32,50.04&plusmn;6.19,56.52&plusmn;4.66,63.06&plusmn;3.73),thedifferencewasstatisticallysignificant(P<0.05).Thepassiveactivitylevelsofpostoperativekneejointhadnosignificantdifference.TheserumCRPlevelofcontinuousfemoralnerveblockgroupwaslowerthancontinuousintravenousanalgesiagroupandbothgroupsreachedthepeakinthe4thday,buttherewasnosignificantdifferencebetweenthetwogroups(P>0.05).Thepostoperativelowerextremitydeepvenousthrombosisofpatientsintwogroupshadnosignificantdifference.ConclusionContinuousfemoralnerveblockcouldbemoreeffectiveinreducingpostoperativepainscoresofpatientswithtotalkneearthroplasty,whichwasmoreobviousafteroperationandcouldpromotefunctionalrecoveryinearlykneemoreefficiently.【Keywords]Totalkneearthroplasty;Analgesia;Postope...