CAJ | 학술논문

目的：比较比较连续股神经阻滞（CFNB）和持续静脉镇痛（CIA）对全膝关节置换（TKA）术后疼痛及早期膝关节功能康复的影响。方法：将2012年1月～2013年12月于我院初次行单侧全膝关节置换的22例患者随机分为比较连续股神经阻滞组（n=11例）和持续静脉镇痛组（n=11例）。观察和比较两组患者术后视觉模拟评分VAS、CPM度数、被动屈伸活动度、术后CRP水平及术后下肢深静脉血栓形成情况。结果：术后第1、2、3、4天，连续股神经阻滞组VAS评分（5.06±0.23、4.78±0.12、3.04±0.52、2.676±0.71）明显低于持续静脉镇痛组(7.32±0.76、6.84±0.91、5.90±0.78、3.46±0.85)，差异均有统计学意义（P<0.05）；术后第2、3、4、5天，连续股神经阻滞组C P M锻炼度数（68.34±4.66、74.06±5.31、82.63±3.84、86.56±4.78）明显高于持续静脉镇痛组(44.82±4.32、50.04±6.19、56.52±4.66、63.06±3.73)，差异均有统计学意义（P<0.05）；两组患者术后膝关节被动活动度比较无统计学差异；连续股神经阻滞组术后患者血清CRP水平低于持续静脉镇痛组，均在术后第4天达到峰值，但组间比较均无统计学差异（P>0.05）；两组患者术后双下肢深静脉血栓形成情况比较无统计学差异。结论：连续股神经阻滞能够更加有效地降低全膝关节置换患者术后的疼痛评分，术后镇痛效果更为明显，更加有效地促进患者早期膝关节功能康复。
목적：비교비교련속고신경조체（CFNB）화지속정맥진통（CIA）대전슬관절치환（TKA）술후동통급조기슬관절공능강복적영향。방법：장2012년1월～2013년12월우아원초차행단측전슬관절치환적22례환자수궤분위비교련속고신경조체조（n=11례）화지속정맥진통조（n=11례）。관찰화비교량조환자술후시각모의평분VAS、CPM도수、피동굴신활동도、술후CRP수평급술후하지심정맥혈전형성정황。결과：술후제1、2、3、4천，련속고신경조체조VAS평분（5.06±0.23、4.78±0.12、3.04±0.52、2.676±0.71）명현저우지속정맥진통조(7.32±0.76、6.84±0.91、5.90±0.78、3.46±0.85)，차이균유통계학의의（P<0.05）；술후제2、3、4、5천，련속고신경조체조C P M단련도수（68.34±4.66、74.06±5.31、82.63±3.84、86.56±4.78）명현고우지속정맥진통조(44.82±4.32、50.04±6.19、56.52±4.66、63.06±3.73)，차이균유통계학의의（P<0.05）；량조환자술후슬관절피동활동도비교무통계학차이；련속고신경조체조술후환자혈청CRP수평저우지속정맥진통조，균재술후제4천체도봉치，단조간비교균무통계학차이（P>0.05）；량조환자술후쌍하지심정맥혈전형성정황비교무통계학차이。결론：련속고신경조체능구경가유효지강저전슬관절치환환자술후적동통평분，술후진통효과경위명현，경가유효지촉진환자조기슬관절공능강복。
Objective To compare the effect of continuous femoral nerve block (CFNB) and continuous intravenous analgesia (CIA) on postoperative pain and rehabilitation of early knee joint function after total knee arthroplasty (TKA).Method 22 patients were randomly divided into comparison continuous femoral nerve block group (n=11 patients) and continuous intravenous analgesia group (n=11 cases), who were performed primary unilateral total knee arthroplasty in our hospital from January 2012 to December 2013. Observe and compare postoperative visual analog scale VAS, CPM degree, passive range of motion, postoperative CRP levels and postoperative deep venous thrombosis of the two groups.Results 1,2,3,4 days after the operation, VAS scores of continuous femoral nerve block group (5.06 ± 0.23, 4.78 ± 0.12, 3.04 ± 0.52, 2.676 ± 0.71) were significantly lower than that of continuous intravenous analgesia group (7.32 ± 0.76, 6.84 ± 0.91, 5.90 ± 0.78, 3.46 ± 0.85), the difference was statistically significant (P<0.05). 2,3,4,5 days after the operation, CPM exercise degrees of continuous femoral nerve block group (68.34 ± 4.66, 74.06 ± 5.31, 82.63 ± 3.84, 86.56 ± 4.78) were significantly higher than that of continuous intravenous analgesia group (44.82 ± 4.32, 50.04 ± 6.19, 56.52 ± 4.66, 63.06 ± 3.73), the difference was statistically significant (P<0.05). The passive activity levels of postoperative knee joint had no significant difference. The serum CRP level of continuous femoral nerve block group was lower than continuous intravenous analgesia group and both groups reached the peak in the 4th day, but there was no significant difference between the two groups (P>0.05). The postoperative lower extremity deep venous thrombosis of patients in two groups had no significant difference.Conclusion Continuous femoral nerve block could be more effective in reducing postoperative pain scores of patients with total knee arthroplasty, which was more obvious after operation and could promote functional recovery in early knee more efficiently.