丁丙诺啡联合股神经阻滞对膝关节置换术后快速康复的影响

摘要

Objective: To observe the analgesic effect of buprenorphine combined with femoral nerve block for the primary total knee arthroplasty ( TKA) and the short-term postoperative rehabilitation. Methods:Sixty-three cases of total knee arthroplasty were retrospectively analyzed from June 2016 to June 2017. They were divided into two groups according to the method of femoral nerve anaesthetised. The patients in group A were given ropivacaine with the addition of 0.3 mg of buprenorphine. The patients in group B were given ropiv-acaine. Postoperative resting and activities of the visual Analogue Score( VAS) at 12、24、36、48、60、72 hours, the range of motion( ROM) in 7 days, the consumption of oxycodone acetaminophen in 3 days and the duration of the hospital stay were compared between two groups. Results:The resting state VAS in group A was signifi-cantly lower than that in group B at 12, 24, 36, 48 hours ( P<0.05) , and there was no significant difference in 60, 72 hours ( P>0.05) . The activities state VAS in group A was significantly lower than that in group B at 12, 24, 36, 48, 60, 72 hours ( P<0.05);The consumption of oxycodone acetaminophen group A was signifi-cantly lower than group B in 1, 2 day and total consumption ( P<0.05);The ROM of group A was significant-ly greater than that of group B in 7 days post-surgery ( P<0.05);There was no significant difference in hospi-tal stay between the two groups( P>0.05) . Conclusion:The results showed that buprenorphine combined with femoral nerve block can improve the short-term analgesic effect and reduce the consumption of morphine drugs, which is beneficial to the functional exercise and rehabilitation of the patients.%目的:观察丁丙诺啡联合股神经阻滞,用于首次单侧全膝关节置换术后患者的镇痛效果及术后近期对功能锻炼的影响.方法:选择我科2016年6月至2017年6月全膝关节置换术行股神经阻滞62例,根据股神经阻滞时是否使用丁丙诺啡分为A组(丁丙诺啡+罗哌卡因)和B组(罗哌卡因).比较两组患者术后12、24、36、48、60、72h静息和活动视觉模拟评分(Visual Analogue Score,VAS),术后3d的氨酚羟考酮使用量,术后7d膝关节关节活动度(Range of motion,ROM),以及住院时间的情况.结果:A组患者术后静息状态VAS评分在12、24、36、48h低于B组(P<0.05),在60、72h差异无统计学意义(P>0.05);A组患者术后活动状态VAS评分在12、24、36、48、60、72h低于B组(P<0.05);术后氨酚羟考酮使用量在1、2d,以及总使用量A组小于B组(P<0.05).患者术后7d膝关节活动度A组大于B组(P<0.05);两组患者住院时间差异无统计学意义(P>0.05).结论:使用丁丙诺啡联合股神经阻滞可改善术后短期镇痛效果,减少镇痛药物使用,有利于患者早期功能锻炼和快速康复.