摘要
目的 比较不同镇痛方法对全膝关节置换术（TKA）术后镇痛的效果.方法 择期单侧TKA患者80例,随机分为4组：局部镇痛组（L组）、静脉镇痛组（Ⅰ组）、硬膜外镇痛组（E组）、髂筋膜间隙阻滞复合静脉镇痛组（F＋Ⅰ组）,术中均采用腰麻与硬膜外联合麻醉.记录术前与术后静息与运动的VAS评分;记录其他镇痛药物的额外使用次数;记录术前与术后8、24 h时IL-6和皮质醇水平;记录术后患者患膝主动运动功能情况（患膝主动屈伸至90°角的例数）;记录术后不良反应.结果 术后各个时间段静息与运动VAS评分、术后8、24 h的IL-6水平、术后24 h皮质醇水平硬膜外镇痛组和髂筋膜间隙阻滞复合静脉镇痛组明显低于静脉镇痛组和局部镇痛组（P＜0.05）.结论 膝关节置换术后行髂筋膜间隙阻滞复合静脉镇痛的效果与持续硬膜外镇痛的效果相当,但优于静脉镇痛和局部镇痛,且不良反应较少,可早期行功能锻炼.
Objective To compare the effect of different postoperative analgesic methods after total knee arthroplasty （TKA）.Methods Eighty patients with unilateral TKA were randomly divided into four groups （n=20）： continuous local analgesia group （group L）, continuous intravenous analgesia group （group Ⅰ）, continuous epidural analgesia group （group E） , and fascia iliac compartment block combined with continuous intravenous analgesia group （group FI）.All patients received combined spinal and epidural analgesia.Visual analogue scale （VAS） , additional use of analgesic drugs, level of IL-6 and cortisol, involved knee active movement time,adverse effects were observed.Results During postoperative resting and moving state,VAS of continuous epidural analgesia group and fascia iliac compartment block combined with continuous intravenous analgesia group, as well as IL-6 and cortisol, were significantly lower than that of the other two groups.Conclusion The effects of fascia iliac compartment block combined with continuous intravenous analgesia is comparable to the continuous epidural analgesia group, and better than continuous local analgesia and continuous intravenous analgesia group, with less adverse reaction.
出处
《实用疼痛学杂志》
2015年第6期418-422,共5页
Pain Clinic Journal
基金
2012年度南京军区医学科技创新资助项目
关键词
髂筋膜间隙阻滞
疼痛
手术后
镇痛
患者控制
关节成形术
置换
膝
Fascia iliac compartment block
Pain,postoperative
Analgesia,patient-controlled
Arthroplasty,replacement,knee
