目的：探讨连续股神经阻滞（CFNB）联合硬膜外吗啡镇痛在老年患者全膝关节置换术（TKA）中的应用效果。方法：抽选2010年3月-2015年4月本院收治的86例行单侧TKA术的患者，随机分为对照组（n=43，予以CFNB麻醉镇痛）和观察组（n=43，予以CFNB复合硬膜外吗啡镇痛），比较两组患者术后不同时点静息状态、运动锻炼时VAS评分、肌力评分、镇静满意度及膝关节弯曲度；观察两组术后24 h应激反应指标及不良反应的差异。结果：观察组术后24、48、72 h静息状态及运动锻炼时VAS评分均明显低于对照组（P<0.05）；肌力评分、膝关节弯曲度高于对照组（P<0.05）。两组术后24、48、72 h镇静程度均可，比较差异均无统计学意义（P>0.05）。观察组术后24 h血糖、CRP、WBC、皮质醇水平等应激反应指标均低于对照组（P<0.05）。观察组6例有轻度皮肤瘙痒，但均可耐受，对照组未见不良反应。结论：CFNB联合硬膜外吗啡麻醉用于老年患者TKA术后镇痛，对下肢肌力影响轻微，镇痛效果佳，应激反应及不良反应发生率低。%Objective:To study application value of continuous femoral nerve block combined with epidural anesthesia in elderly patients undergoing total knee replacement.Method:The 86 cases of unilateral TKA patients in our hospital in March 2010 to April 2015 were selected,randomly divided into the control group (n=43,the implementation of CFNB anesthesia analgesia) and the observation group (n=43,to be CFNB combined with epidural morphine analgesia),VAS score, strength score,sedation degree of knee joint curvature between the two groups and point of resting and exercise after operation were compared; The differences of 24h stress reaction and adverse reactions were observed in the two groups.Result:VAS score of 24,48,72 h resting state and exercise time in the observation group was significantly lower than the control group(P<0.05);muscle strength score, knee flexion was higher than the control group (P<0.05).Two groups of postoperative 24,48,72 h sedation level can be compared,there was no significant difference (P>0.05).The 24 h blood glucose,CRP,WBC and cortisol levels in the observation group were significantly lower than those in the control group(P<0.05).The observation group of 6 cases with mild skin itching,but can be tolerated,no adverse reactions in the control group. Conclusion:CFNB combined with epidural morphine anesthesia for postoperative analgesia in elderly patients with TKA, the lower limb muscle strength,analgesic effect is excellent,stress reaction and adverse reaction rate is low.
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