CAJ | 학술논문

背景：疼痛是全膝关节置换后阻碍患者早期恢复的重要原因，持续硬膜外镇痛和持续股神经阻滞均是全膝关节置换后镇痛的有效方法，但哪种方法镇痛效果更好且并发症较少一直存在争议。 　　目的：比较全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的临床疗效及安全性。 　　方法：计算机检索Cochrane-Library、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang等数据库，同时检索学位论文、会议论文等，检索时间为各数据库建库至2014-10-01，纳入全膝关节置换后持续硬膜外镇痛与持续股神经阻滞的随机对照试验。采用Cochrane系统评价的方法进行评价，用RevMan 5.0软件进行统计学分析。 　　结果与结论：共纳入12篇随机对照试验，4篇英文，8篇中文，共680例患者，其中持续股神经阻滞组患者343例，持续硬膜外镇痛组患者337例。Meta分析结果显示，持续股神经阻滞组与持续硬膜外镇痛组在全膝关节置换后6，12，24，48 h的目测类比评分差异均无显著性意义；但与持续硬膜外镇痛组相比，持续股神经阻滞可减少恶心/呕吐(RR=0.36，95%CI：0.21-0.63，P=0.003)、尿潴留(RR=0.08，95%CI：0.04-0.16， P <0.001)和头晕(RR=0.24，95%CI：0.06-0.99，P=0.05)的发生率。提示与硬膜外镇痛相比，全膝关节置换后持续股神经阻滞镇痛同样可以提供良好的镇痛效果，有利于患者早期功能恢复训练，且不良反应少，是一种安全、有效的镇痛方法。
배경：동통시전슬관절치환후조애환자조기회복적중요원인，지속경막외진통화지속고신경조체균시전슬관절치환후진통적유효방법，단나충방법진통효과경호차병발증교소일직존재쟁의。 　　목적：비교전슬관절치환후지속경막외진통여지속고신경조체적림상료효급안전성。 　　방법：계산궤검색Cochrane-Library、PubMed、EMBASE、Web of Science、CBM、CNKI、VIP、WanFang등수거고，동시검색학위논문、회의논문등，검색시간위각수거고건고지2014-10-01，납입전슬관절치환후지속경막외진통여지속고신경조체적수궤대조시험。채용Cochrane계통평개적방법진행평개，용RevMan 5.0연건진행통계학분석。 　　결과여결론：공납입12편수궤대조시험，4편영문，8편중문，공680례환자，기중지속고신경조체조환자343례，지속경막외진통조환자337례。Meta분석결과현시，지속고신경조체조여지속경막외진통조재전슬관절치환후6，12，24，48 h적목측류비평분차이균무현저성의의；단여지속경막외진통조상비，지속고신경조체가감소악심/구토(RR=0.36，95%CI：0.21-0.63，P=0.003)、뇨저류(RR=0.08，95%CI：0.04-0.16， P <0.001)화두훈(RR=0.24，95%CI：0.06-0.99，P=0.05)적발생솔。제시여경막외진통상비，전슬관절치환후지속고신경조체진통동양가이제공량호적진통효과，유리우환자조기공능회복훈련，차불량반응소，시일충안전、유효적진통방법。
BACKGROUND:Pain is the significant cause for patients with early rehabilitation after total knee arthroplasty. Continuous epidural analgesia and continuous femoral nerve block are effective analgesic methods after total knee arthroplasty, however, which method has better effects and less complications remains controversial. OBJECTIVE:To compare the efficacy and safety of countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty. METHODS:We searched Cochrane Library, PubMed, EMBASE, Web of Science, CBM, CNKI, VIP, and WangFang. Meanwhile, we also searched conference papers and academic dissertation. The retrieval time was from database establishment to October 1, 2014. Studies of randomized control ed trials on countious femoral nerve block and continuous epidural analgesia after total knee arthroplasty were included. We evaluated the quality of these included studies and analyzed data by Cochrane Col aboration’s RevMan 5.0 software. RESULTS AND CONCLUSION:A total of 12 randomized control ed trials (4 English articles and 8 Chinese articles) involving 680 patients were included. There were 343 patients with countious femoral nerve block and 337 patients with continuous epidural analgesia. Meta-analysis results revealed that no significant differences in visual analog scale scores were detected between the countious femoral nerve block and continuous epidural analgesia groups at 6, 12, 24 and 48 hours after total knee arthroplasty. However, compared with the continuous epidural analgesia group, countious femoral nerve block could decrease the incidences of nausea/vomiting (RR=0.36, 95%CI:0.21-0.63, P=0.003), urine retention (RR=0.08, 95%CI:0.04-0.16, P<0.001) and dizziness (RR=0.24, 95%CI:0.06-0.99, P=0.05). These results indicate that compared with epidural analgesia, countious femoral nerve block after total knee arthroplasty provided a strong analgesia effect, contributed to early functional training, had less adverse reactions, and was a safe and effective analgesic method.