连续股神经阻滞联合硬膜外吗啡镇痛在老年患者全膝关节置换术中的应用

摘要

Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.%目的：探讨超声引导下连续股神经阻滞(CFNB)联合单次硬膜外腔吗啡镇痛在老年患者全膝关节置换术(TKA)中的应用。方法80例行单侧全膝关节置换术的老年患者,男35例,女45例,年龄60~79岁,ASA Ⅱ或Ⅲ级,随机均分为两组：CFNB 复合硬膜外吗啡组(FNM 组)和CFNB 组(FN 组)。手术缝合切口时,FNM 和 FN 组经硬膜外导管分别注入0.1%吗啡2 ml 和生理盐水2 ml。手术结束后两组均于超声引导下行0.2%罗哌卡因 CFNB。分别记录术后24、48、72、96 h 时静息状态、主动和被动功能锻炼时 VAS 评分及患肢被动弯曲度；观察两组患者术后第5天的活动情况和满意度。结果术后24 h FNM 组静息状态时、主动锻炼和被动锻炼时 VAS 评分明显低于,膝关节弯曲度明显大于 FN 组(P <0.05或 P <0.01)；FNM 组患者术后第5天下床活动评分明显高于,术后满意度评分明显低于 FN 组(P <0.05)。结论超声引导下 CFNB 联合硬膜外吗啡早期镇痛可明显改善老年患者 TKA 术后镇痛,康复效果佳。