CAJ | 학술논문

目的：评估股神经阻滞麻醉联合硬膜外自控镇痛对全膝关节置换术后的镇痛效果。方法在患者知情同意后分为2组，术后接受0．25％左布比卡因股神经阻滞麻醉联合硬膜外自控镇痛的40例为实验组，另40例术后仅行硬膜外自控镇痛（对照组）。术后48 h内分0～6、6～24、24～48 h 3个周期测量并记录患者的疼痛强度、自控镇痛药物使用量、补充镇痛药物量、呼吸频率、镇静评分、血氧饱和度（ SPO2）、血压，以及恶性、呕吐、瘙痒等不良反应发生率。结果实验组每个周期内膝关节静止和运动状态下直观类比标度值（ VAS）≥50分的患者数（共9例次）显著少于对照组（共56例次），2组比较差异有统计学意义（P＜0．01或＜0．05）；实验组在每个周期内使用硬膜外自控镇痛药物的量显著少于对照组，2组比较差异有统计学意义（P＜0．05）。实验组第1个周期（0～6 h）内恶心、呕吐使用、止吐药例数（分别为7、1、7例）和喷他佐辛使用量（6 ml）显著低于对照组（分别为16、7、16例和18 ml），2组比较差异均有统计学意义（P＜0．01或＜0．05）。结论股神经阻滞麻醉联合硬膜外自控镇痛是全膝关节置换术后一种有效的镇痛方法。
목적：평고고신경조체마취연합경막외자공진통대전슬관절치환술후적진통효과。방법재환자지정동의후분위2조，술후접수0．25％좌포비잡인고신경조체마취연합경막외자공진통적40례위실험조，령40례술후부행경막외자공진통（대조조）。술후48 h내분0～6、6～24、24～48 h 3개주기측량병기록환자적동통강도、자공진통약물사용량、보충진통약물량、호흡빈솔、진정평분、혈양포화도（ SPO2）、혈압，이급악성、구토、소양등불량반응발생솔。결과실험조매개주기내슬관절정지화운동상태하직관류비표도치（ VAS）≥50분적환자수（공9례차）현저소우대조조（공56례차），2조비교차이유통계학의의（P＜0．01혹＜0．05）；실험조재매개주기내사용경막외자공진통약물적량현저소우대조조，2조비교차이유통계학의의（P＜0．05）。실험조제1개주기（0～6 h）내악심、구토사용、지토약례수（분별위7、1、7례）화분타좌신사용량（6 ml）현저저우대조조（분별위16、7、16례화18 ml），2조비교차이균유통계학의의（P＜0．01혹＜0．05）。결론고신경조체마취연합경막외자공진통시전슬관절치환술후일충유효적진통방법。
Objective To evaluate clinical effects of single-injection femoral nerve block combined with patient-controlled epidural analgesia on patients undergoing total knee replacement .Methods With the knowledge and consent of patients , 80 patients were divided into 2 groups:the experimental group and the control group .Forty patients in the experimental group received a single-in-jection femoral nerve block combined with patient-controlled epidural analgesia , while another 40 patients in the control group received self-controlled epidural analgesia alone .The forty-eight-hour period after surgery were divided into 3 different periods , i.e.the 0-6 h, 6-24 h and 24-48 h periods.Pain intensity, the dosage of patient-controlled epidural analgesic drug , the dosage of supplemental analge-sic drug, respiratory frequency, analgesic scores, SPO2, blood pressure, and such side effects as nausea, vomiting and pruritus were detected and recorded .Results Median visual analog scale ( VAS) for the patients in the experimental group at rest and movement was significantly lower (9 case-times) than that of the control group (56 case-times), and statistical significance could be seen , when com-parisons were made between the 2 groups(P<0.01 or <0.05).The dosage of patient-controlled epidural analgesic drug used by the experimental group during each period was significantly lower than that of the control group , and statistical differences could be noted , when comparisons were made between the 2 groups(P<0.05).During the first period of 0~6 h, there occurred in the experimental group 7 cases of nausea, 1 case of vomiting, 7 cases of antiemetic drug application, and the dosage of Pentazocine (6 ml), which were all significantly lower than those of the control group (16, 7, 16 cases and18 ml respectively).Statistical significance could be noted , when comparisons were made between the 2 groups(P<0.01 or <0.05).Conclusion The combination of femoral nerve block with epidural analgesia was an effective pain control regimen for patients undergoing total knee replacement .