全膝关节置换术后不同镇痛方法的比较研究

发布时间：2018-04-04 02:37

  本文选题：股神经阻滞　切入点：鸡尾酒　出处：《苏州大学》2014年硕士论文

【摘要】：目的 通过观察患者自控静脉镇痛（Patient controlled intravenous analgesia,PCIA）、超声引导下连续股神经阻滞（Continuous femoral nerve block,CFNB）与关节周围注射鸡尾酒法(Cocktail recipes mixed liquid analgesia,CRMA)用于全膝关节置换术(Total knee arthroplasty, TKA)后镇痛效果，病人早期膝关节活动，不良反应发生率等，探讨三种镇痛方法的优缺点，为寻找安全、有效及利于全膝关节置换术后患者早期膝关节功能恢复的镇痛方法提供理论依据。 方法 选择ASAI-III级拟行全膝关节置换术的患者63例，随机分为三组，静脉自控镇痛组（PCIA组）21例，连续股神经阻滞组（CFNA组）21例，鸡尾酒组（CRMA组）21例，麻醉方法均采用气管内插管全身麻醉。PCIA组，负荷剂量芬太尼0.05mg，背景剂量为2ml/h, PCA每次2ml，锁定时间为10min，持续48h。CFNA组在麻醉诱导插管后，利用超声定位行股神经阻滞并置管，给负荷剂量0.375%盐酸罗哌卡因20ml，术后连接病人自控镇痛泵（PCA），背景剂量为4.5ml/h，PCA每次4ml，锁定时间为60min，持续48h。CRMA组于术中人工关节放置好后在关节腔周围注射“鸡尾酒”（0.75%盐酸罗哌卡因50ml+吗啡5mg+肾上腺素0.5mg+凯纷50mg+地塞米松5mg），并留置导管，在术后24h再推一次混合药液（凯纷50mg+0.75%盐酸罗哌卡因20ml）。记录（观察指标）术后即刻、术后6h、12h、24h及48h患膝静息及主被动伸屈膝活动时的疼痛评分，镇静评分，股四头肌肌力，术后即刻、6h、12h、24h、48h患膝主动屈曲时的角度，术后初次下床活动时间，术后2周膝关节活动度，术后不良反应及并发症的发生率，患者满意度。所有资料采用Stata12.0软件进行统计学分析，P�d0.05时认为差异有显著性。 结果 PCIA组术后即刻、6h、12h、24h、48h的静息状态疼痛评分，均明显高于CFNA组和CRMA组，差异有显著性（P�d0.05），CFNA组与CRMA组各时间点静息状态疼痛评分无明显差异（P�e0.05）。术后即刻、6h、12h、24h、48h，，三组患者主被动伸屈膝活动的疼痛评分差异有显著性（P�d0.05），PCIA组疼痛评分明显高于CFNA组和CRMA组，在术后即刻、6h、24h，CFNA组疼痛评分与CRMA组相比差异无显著性（P�e0.05），但在术后12h及48h，CFNA组疼痛评分明显低于CRMA组，差异有显著性（P�d0.05）。在术后即刻、6h、12h、24h、48h，三组患者的镇静评分比较差异无显著性（P�e0.05）。三组患者在术后即刻、6h、12h、24h、48h的肌力比较差异无显著性（P�e0.05）。在不引起剧烈疼痛的情况下，PCIA组在术后即刻、6h、12h、24h、48h的膝关节弯曲角度明显小于CFNA组和CRMA组（P�d0.05），CFNA组在术后即刻、6h、24h膝关节弯曲角度与CRMA组相比差异无显著性（P�e0.05），术后12h和48h时CFNA组膝关节弯曲角度明显大于CRMA组（P�d0.05）。PCIA组患者初次下床活动时间明显大于CFNA组和CRMA组，差异有显著性（P�d0.05），CFNA组与CRMA组患者初次下床活动时间相比差异无显著性（P�e0.05）。术后两周膝关节弯曲角度，PCIA组明显小于CFNA组和CRMA组，差异有显著性（P0.05），CFNA组和CRMA组相比差异无显著性（P0.05）。三组患者不良反应发生率，PCIA组明显高于CFNA组和CRMA组，差异有显著性（P�d0.05）。术后患者满意度PCIA组明显低于CFNA组和CRMA组，差异有显著性（P�d0.05），而CFNA组和CRMA组相比，差异无显著性（P�e0.05）。 结论 TKA术后患者镇痛，CFNA和CRMA的镇痛效果明显优于PCIA；CFNA和CRMA对早期膝关节功能的恢复明显优于PCIA；CFNA较CRMA在持续性镇痛方面更有优势。
[Abstract]:objective
Through the observation of patient-controlled intravenous analgesia (Patient controlled intravenous analgesia, PCIA), ultrasound-guided continuous femoral nerve block (Continuous femoral nerve block, CFNB) and periarticular injection (Cocktail recipes mixed liquid cocktail analgesia, CRMA) for total knee arthroplasty (Total knee, arthroplasty, TKA) after the analgesic effect of patients with early stage the knee joint activity, the incidence of adverse reactions, discuss advantages and disadvantages of the three kinds of methods of analgesia, to find safe, effective and beneficial to total knee arthroplasty in patients with knee joint function recovery analgesia methods and provide a theoretical basis.
Method
63 patients of grade ASAI-III underwent total knee replacement surgery, were randomly divided into three groups, intravenous analgesia group (PCIA group) 21 cases, continuous femoral nerve block group (CFNA group) 21 cases, cocktail group (CRMA group) 21 cases were treated with endotracheal intubation anesthesia group.PCIA general anesthesia a loading dose of fentanyl 0.05mg, background dose of 2ml/h, PCA, 2ml each time, the lock time is 10min, duration of 48h.CFNA group in intubation after induction of anesthesia, the use of ultrasound localization of femoral nerve block and tube, to a loading dose of 0.375% ropivacaine hydrochloride 20ml, postoperative patient-controlled analgesia pump connection (PCA), background dose was 4.5ml/h, PCA every time 4ml, the locking time is 60min, continuous 48h.CRMA group in artificial joint replacement in place around the "cocktail joint cavity" injection (0.75% 50ml+ morphine 5mg+ ropivacaine hydrochloride adrenaline 0.5mg+ flurbiprofen 50mg+ dexamethasone 5mg), and postoperative indwelling catheter, in 2 4h push again mixed liquor (flurbiprofen 50mg+0.75% ropivacaine hydrochloride (20ml). Record the observation index) immediately after surgery, postoperative 6h, 12h, 24h and 48h of knee resting and passive extension activities of the knee pain score, sedation score, unit four biceps muscle strength, immediately after the operation, 6h, 12h 24h, 48H, knee flexion angle when the first, postoperative ambulation time, degree of knee joint activity 2 weeks after operation, the incidence of adverse reactions, postoperative complications and patient satisfaction. All data were statistically analyzed using Stata12.0 software, P? 0.05 was considered significant.
Result
PCIA缁勬湳鍚庡嵆鍒

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