目的：评估伤口单次局部浸润罗哌卡因联合静脉自控镇痛对全膝关节置换（TKA ）术后镇痛的效果及术后早期膝关节康复训练的影响。方法选择腰麻下行膝关节置换手术的患者50例，根据镇痛方式分为两组，罗哌卡因组（25例）：术毕切口浸润0．25％罗哌卡因20 ml，术后行静脉自控镇痛（PCIA）；对照组（25例）：术毕切口浸润生理盐水20 ml，术后行PCIA。采用视觉模拟评分法（VAS）评估不同时间点的镇痛效果，不同时间评定术后康复训练依从性、膝关节主动活动度（ROM）、膝关节功能。结果术后4、6、8、12 h VAS 评分：罗哌卡因组分别为1.28分±1.03分、2.17分±1.67分、2.13分±1.76分、2.38分±0.34分，对照组分别为2.75分±1.09分、3.25分±1.29分、4.50分±1.51分、4.62分±1.60分，两组比较差异有统计学意义（P＜0.01）。术后24、48 h VAS 评分：罗哌卡因组分别为3.20分±1.21分、3.17分±0.84分，对照组分别为3.28分±1.21分、3.56分±1.19分，两组比较差异无统计学意义（P＞0.05）。罗哌卡因组与对照组术后康复训练依从性、膝关节ROM及HSS评分比较差异均有统计学意义（P＜0.01）。结论应用罗哌卡因局部浸润联合PCIA用于TKA术后镇痛是一种安全有效的镇痛方法，有利于膝关节术后功能的恢复，具有较好的临床应用价值。%Objective To assess single ropivacaine local infiltration for postoperative analgesia and early postoperative rehabilitation in total knee arthroplasty (TKA ).Methods Fifty patients with TKA were divided into two equal groups;Ropivacaine group (25 cases):surgery incision infiltration 0.25% ropivacaine 20 ml,and postoperative in-travenous analgesia(PCIA);Control group (25 cases):invasive surgery incision saline 20 ml,and PCIA.Visual ana-log scale(VAS)assessed at different time points using the analgesic effect,assessed at different times after rehabilita-tion training compliance,active knee ROM and knee function.Results At postoperative 4,6,8,12h VAS scores of ropivacaine group were 1.28 ±1.03,2.17 ±1.67,2.13 ±1.76,2.38 ±0.34;Control group were 2.75 ±1.09, 3.25 ±1.29,4.50 ±1.51,4.62 ±1.60,differences were statistically significant (P<0.01),but differences were not statistically significant postoperative 24,48 h (P>0.05):ropivacaine group were 3.20 ±1.21,3.17 ±0.84;control group were 3.28 ±1.21,3.56 ±1.19.Ropivacaine group and the control group after rehabilitation training compliance,knee ROM and HSS scores were statistically significant differences (P<0.01 ).Conclusions Ropiva-caine local infiltration combined with PCIA for analgesia after TKA is a safe and effective method.
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