局部浸润注射和股神经阻滞在全膝关节置换术后病人镇痛效果的比较：系统综述和荟萃分析

发布时间：2018-04-09 04:18

本文选题：局部浸润注射　切入点：股神经阻滞　出处：《山东大学》2017年硕士论文

【摘要】：研究目的:系统评价不同镇痛方式在全膝关节置换术后的疗效,为全膝关节置换术后疼痛的临床治疗提供依据。对局部浸润注射和股神经阻滞在全膝关节置换术后镇痛的效果进行荟萃分析。材料与方法:根据研究目的制定相应的纳入标准和排除标准。制定系统且详尽的检索策略,检索 Pubmed,Embase,Cochrane Central,Scopus,Web of knowledge 数据库关于局部浸润注射(Local infiltration analgesia,LIA)和股神经阻滞(Femoral nerve block,FNB)在全膝关节置换术后病人镇痛效果的比较的文献,对纳入的文献进行评价。仔细阅读全文,提取VAS评分、膝关节活动度、吗啡消耗量、住院天数等相关数据。由两名研究人员独立提取数据并填写制定好的Excel表格,对比无误后用Review Manager 5.3 进行 Meta 分析。结果:共8篇文献符合纳入标准,累及病例763例,其中LIA380例,FNB383例。8篇文献评价得分10.5± 1.30,均为高质量研究。休息时或活动时术后连续注射FNB VAS评分优于连续注射LIA;休息时或活动时术后单次注射FNB VAS评分与LIA无统计学差异;连续注射FNB膝关节活动度优于连续注射LIA;连续注射FNB辅助下膝关节活动度与连续注射LIA无统计学差异;连续注射FNB吗啡消耗量与连续注射LIA无统计学差异;连续注射或单次注射LIA住院天数均优于FNB。结论:LIA和FNB比较:FNB病人疼痛减轻明显,术后膝关节活动度恢复程度高;LIA住院时间缩短较明显。相较于FNB,LIA的学习曲线短、易于操作,适合于临床疼痛程度适中,对住院天数有要求的患者。FNB疼痛缓解和膝关节活动度改善较好,适合疼痛程度较重的患者。
[Abstract]:Objective: to evaluate the efficacy of different analgesic methods after total knee arthroplasty (TKA).The effect of local invasive injection and femoral nerve block on analgesia after total knee arthroplasty was analyzed.Materials and methods: relevant inclusion criteria and exclusion criteria were established according to the purpose of the study.A systematic and detailed search strategy was developed to search the literature on the analgesic effect of local infiltration analgesia (LIA) and femoral nerve block (Femoral nerve block) in patients undergoing total knee arthroplasty (TKA), and to evaluate the literature included in the Pubmedmed-Embase Cochrane Central Web of knowledge database on the comparison of local infiltration analgesia (LIA) and femoral nerve block (Femoral nerve block FNBs) after total knee arthroplasty (TKA).Read the full text carefully and extract relevant data such as VAS score, knee motion, morphine consumption, and length of stay.The two researchers independently extracted the data and filled out the established Excel form. After the comparison was correct, Review Manager 5.3 was used for Meta analysis.Results: a total of 8 articles met the inclusion criteria, and 763 cases were involved. The evaluation scores of LIA380 cases and FNB383 cases were 10.5 卤1.30. All of them were of high quality.The score of continuous injection of FNB VAS was superior to that of continuous injection of Lia at rest or movement, but there was no significant difference between the score of single injection of FNB VAS and that of LIA at rest or during exercise.The range of motion of knee joint by continuous injection of FNB was better than that by continuous injection of Lia, there was no significant difference between continuous injection of FNB and continuous injection of LIA, and there was no significant difference between continuous injection of FNB morphine and continuous injection of LIA.The hospitalization days of continuous injection or single injection of LIA were better than that of FNB.Conclusion compared with FNB, the pain was relieved significantly in the patients with FNB, and the length of stay in the hospital was shorter than that in the patients with FNB, and the recovery degree of motion of the knee joint after operation was higher than that in the control group.Compared with FNBX LIA, the learning curve is shorter and easier to operate, which is suitable for patients with moderate clinical pain.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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