三种镇痛方法对膝关节置换术术后疼痛和膝关节主动屈曲活动度的影响

摘要

目的：分析膝关节置换术后三种不同镇痛方法对术后疼痛和膝关节主动屈曲活动度的影响，为临床术后镇痛方法的选择提供科学依据。方法：将120例膝关节置换术患者按照不同镇痛方法分为自控静脉镇痛组（PCIA ），硬膜外镇痛组（PCEA ）和连续股神经阻滞镇痛组（CFNB ）各40例。结果：三组患者均于术后2hVAS评分较低，术后4h、6h达到最高值，随后逐渐降低，于术后4d达到最低值，三组患者VAS评分变化趋势比较，差异有统计学意义；其中CFNB组评分维持在最低水平变化，其次为PCEA组，PCIA组最高。三组患者均于术后ROM 角度逐渐恢复，三组患者ROM 角度变化趋势比较，差异有统计学意义；其中CFNB 组评分维持在最高水平变化，其次为PCEA组，PCIA组最低。结论：连续股神经阻滞镇痛效果和膝关节主动屈曲活动度恢复明显优于自控静脉镇痛组和硬膜外镇痛组。%Objective :To analysis of three different knee arthroplasty postoperative analgesia on post‐operative pain and knee flexion impact initiative to provide the scientific basis for the method of choice for clinical postoperative analgesia .Methods:120 cases of knee replacement surgery patients were divided into groups controlled intravenous analgesia (patient control intravenous analgesia ,PCIA) according to different methods of analgesia ,epi‐dural analgesia group (patient controlled epidural analgesia ,PCEA) and continuous femoral nerve block town pain group (continuous femoral nerve block ,CFNB) 40 cases .Results :Three groups of patients were after surgery 2hVAS score lower after 4 ,6h reached the highest value ,and then gradually decreased to the lowest value after 4d , three groups of patients VAS score trends ,the difference was statistically significant ;Which CFNB group change scores remained at the lowest level ,followed by PCEA group ,the highest PCIA group .Three groups of patients were gradually restored in the postoperative ROM angle ,the angle of the three groups of patients ROM trends ,the difference was statistically significant ;which CFNB group score be maintained at the highest levels ,followed by the PCEA group ,the lowest PCIA group .Conclusion:Femoral nerve block analgesia and knee flexion active recovery was better than PCIA group and epidural analgesia group .