两种镇痛方式对全膝关节置换术后疼痛及关节功能影响的随机对照研究
량충진통방식대전슬관절치환술후동통급관절공능영향적수궤대조연구
Effects of two analgesic regimens on the postoperative analgesia and knee functional recovery after unilateral total knee arthroplasty—a randomized controlled trial
  • 万方数据
    中华外科杂志 중화외과잡지
    CHINESE JOURNAL OF SURGERY
    2015年 7期 522-527 ,共6页

    任力%彭丽桦%秦珮珮%闵苏

    임력%팽려화%진패패%민소

    关节成形术,置换,膝%镇痛%股神经%功能恢复 關節成形術,置換,膝%鎮痛%股神經%功能恢複
    관절성형술,치환,슬%진통%고신경%공능회복
    Arthroplasty,replacement,knee%Analgesia%Femoral nerve%Functional recovery
    目的 探讨连续股神经阻滞对全膝关节置换术(TKA)后镇痛效果及关节功能的影响.方法 前瞻性收集2011年1月至2013年12月符合纳入和排除标准的患者资料,共有280例患者入组,年龄40～ 75岁,ASA分级Ⅰ～Ⅲ级.采用随机数字表法将280例患者随机分为连续股神经阻滞(CFNB)组(n=140)和静脉自控镇痛(PCIA)组(n=140).分别观察两组患者术后24、48、72 h、出院时、术后3、6、12个月运动及静息状态下的数字评价量表(NRS)评分,记录术后3、6、12个月中重度疼痛的发生情况及患者关节弯曲度和WOMAC评分,并记录补救药物使用情况及镇痛相关的不良事件.正态分布数据组间比较采用t检验;非正态分布资料组间比较采用Wilcoxon检验;计数资料采用x2检验,不符合x2检验要求的数据采用Fisher确切检验法.结果 CFNB组患者出院时、术后3、6个月运动NRS评分为3、3、3分,PCIA组患者为4、3、3分.CFNB组出院时、术后3、6个月静息NRS评分为3、1、1分,PCIA组为3、2、2分.CFNB组患者出院时(Z=-5.174,P＜0.05)、术后3个月(Z =2.308,P=0.021)、6个月(Z=-2.495,P=0.013)运动NRS评分及静息NRS评分(Z=-2.405,P=0.016;Z=-4.360,P＜0.05;Z=-9.268,P＜0.05)均低于PCIA组.CFNB组患者术后3、6个月关节活动度为92°、103°,PCIA组患者为89°、100°;CFNB组术后3、6个月WOMAC评分为21、18分,PCIA组为24、21分,术后3个月(Z=-2.175,P=0.030)、6个月(Z=-2.471,P=0.013)CFNB组关节活动度大于PCIA组,而WOMAC评分低于PCIA组(Z=-2.467,P=0.014;Z=-2.537,P=0.011).CFNB组镇痛泵人均按压次数和补救用药次数分别为2.3和0.6次,PCIA组为2.6和1.1次,CFNB组镇痛泵人均按压次数(t=-2.984,P=0.003)及补救药物用药次数(t=-3.213,P=0.002)低于PCIA组.两组下肢肌力减退、恶心呕吐等不良事件发生率的差异均无统计学意义(P＞0.05).结论 CFNB可减轻TKA术后疼痛且不良反应少,能够有效地提高TKA术后早、中期膝关节活动度,提高患者生活质量.
    목적 탐토련속고신경조체대전슬관절치환술(TKA)후진통효과급관절공능적영향.방법 전첨성수집2011년1월지2013년12월부합납입화배제표준적환자자료,공유280례환자입조,년령40～ 75세,ASA분급Ⅰ～Ⅲ급.채용수궤수자표법장280례환자수궤분위련속고신경조체(CFNB)조(n=140)화정맥자공진통(PCIA)조(n=140).분별관찰량조환자술후24、48、72 h、출원시、술후3、6、12개월운동급정식상태하적수자평개량표(NRS)평분,기록술후3、6、12개월중중도동통적발생정황급환자관절만곡도화WOMAC평분,병기록보구약물사용정황급진통상관적불량사건.정태분포수거조간비교채용t검험;비정태분포자료조간비교채용Wilcoxon검험;계수자료채용x2검험,불부합x2검험요구적수거채용Fisher학절검험법.결과 CFNB조환자출원시、술후3、6개월운동NRS평분위3、3、3분,PCIA조환자위4、3、3분.CFNB조출원시、술후3、6개월정식NRS평분위3、1、1분,PCIA조위3、2、2분.CFNB조환자출원시(Z=-5.174,P＜0.05)、술후3개월(Z =2.308,P=0.021)、6개월(Z=-2.495,P=0.013)운동NRS평분급정식NRS평분(Z=-2.405,P=0.016;Z=-4.360,P＜0.05;Z=-9.268,P＜0.05)균저우PCIA조.CFNB조환자술후3、6개월관절활동도위92°、103°,PCIA조환자위89°、100°;CFNB조술후3、6개월WOMAC평분위21、18분,PCIA조위24、21분,술후3개월(Z=-2.175,P=0.030)、6개월(Z=-2.471,P=0.013)CFNB조관절활동도대우PCIA조,이WOMAC평분저우PCIA조(Z=-2.467,P=0.014;Z=-2.537,P=0.011).CFNB조진통빙인균안압차수화보구용약차수분별위2.3화0.6차,PCIA조위2.6화1.1차,CFNB조진통빙인균안압차수(t=-2.984,P=0.003)급보구약물용약차수(t=-3.213,P=0.002)저우PCIA조.량조하지기력감퇴、악심구토등불량사건발생솔적차이균무통계학의의(P＞0.05).결론 CFNB가감경TKA술후동통차불량반응소,능구유효지제고TKA술후조、중기슬관절활동도,제고환자생활질량.
    Objective To evaluate the efficacy of continuous femoral block on the postoperative analgesia and functional recovery after total knee arthroplasty(TKA).Methods Two hundreds and eighty patients who underwent TKA were randomized into two groups:the group receiving continuous femoral block (CFNB) and the group receiving patient controlled intravenous analgesia (PCIA),each group included 140 participants.Femoral nerve block with ropivacaine by ultrasonic guidance was performed in group CFNB and group PCIA were administrated with patient controlled intravenous analgesia.Numerical rating scale (NRS) scores at rest and in motion at 24,48,72 h,3,6 and 12 months postoperatively,also the N RS scores at hospital discharge were recorded.The incidence of moderate-severity pain,as well as the degree of knee flexion and the WOMAC scores at 3,6 and 12 months after surgery were analyzed.The rescue analgesic administration and analgesia-related adverse effects were also recorded.Data were expressed as mean ± standard deviation(SD) for normally distributed continuous variables and total number (percent frequency) for categorical variables.If non-normally distributed,data were expressed median inter-quartile range.Student's t-test,Wilcoxon rank test were used to compare results for continuous variables,when appropriate.Chi-square test was used to compare results for categorical variable,Fisher exact test was used for categorical variables when the number of event was less than 5.Results NRS scores of group CFNB in motion was 3(3-4) at discharge time,and 3(2-4),3(2-3) at 3 months and 6 months postoperatively,while the scores of group PCIA was 4 (4-4),3 (3-4),3 (3-4),respectively.And at rest,NRS scores of group CFNB was 3 (2-3),1 (1-2),1 (1-1) at discharge time,and 3,6 months postoperatively.Compared with group PCIA,NRS scores in motion of group CFNB at discharge time (Z =-5.174,P ＜ 0.05) and 3 months(Z =2.308,P =0.021),as well as 6 months postoperatively (Z =-2.495,P =0.013),were significantly lower,also for the NRS scores at rest(Z =-2.405,P =0.016;Z =-4.360,P ＜ 0.05;Z =-9.268,P ＜ 0.05).The degree of knee flexion of group CFNB at 3 and 6 months postoperatively was 92 (88-97),103 (99-106),while the degree of knee flexion of group PCIA was 89 (86-95),100 (97-105);the WOMAC scores of group CFNB at 3 and 6 months postoperatively was 21 (18-26),18 (16-22),while the scores of group PCIA was 24 (20-27),21 (17-24).WOMAC scores of group CFNB was lower compared with groupPCIA at 3(Z =-2.467,P =0.014)and 6(Z =-2.537,P =0.011) months postoperatively while the degree of knee flexion of group CFNB was higher(Z =-2.175,P =0.030;Z =-2.471,P =0.013).Moreover,the frequency of bolus and frequency of rescue of group CFNB was 2.3 and 0.6,while the frequency of group PCIA was 2.6 and 1.1,the frequency of bolus and frequency of rescue were lower in group CFNB (t =-2.984,P =0.003;t =-3.213,P =0.002).The incidence of adverse events such muscle weakness of low limbs,nausea and vomiting were similar in two groups (P ＞ 0.05).Conclusion CFNB can alleviate the postoperative pain after TKA with safety,help improving the shortmiddle-term functions of knee and quality of patients' lives.
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