王海兰

(衡水市第四人民医院疼痛科，河北 衡水　053000)



术前股神经阻滞对全麻下全膝关节置换术老年患者的超前镇痛效果分析

王海兰

(衡水市第四人民医院疼痛科，河北 衡水053000)

目的：探讨全麻下全膝关节置换术前股神经阻滞对老年患者超前镇痛的效果。方法：86例接受全麻下全膝关节置换术治疗的老年患者随机分为观察组(n=43)与对照组(n=43)，观察组给予术前股神经阻滞+全身麻醉，对照组给予单纯全身麻醉，对比两组患者术后疼痛视觉模拟评分(visual Analogue Scale，VAS)、镇痛药物使用情况及不良反应。结果：术后24 h观察组VAS评分显著低于对照组(P<0.01)；观察组术后首次使用镇痛药物时间显著长于对照组(P<0.01)，术后48 h内镇痛药物使用次数显著少于对照组(P<0.01)，术后48 h镇痛药物使用率显著低于对照组(P<0.05)；观察组不良反应发生率为显著低于对照组的48.8%(P<0.01)。结论：术前股神经阻滞用于全麻下老年全膝关节置换术的超前镇痛，能够更加有效的缓解患者围手术期疼痛程度，减少镇痛药物使用量，降低不良反应发生率，值得推广。

股神经阻滞；膝关节置换；超前镇痛

【Abstract】Objective：To discuss the Analysis of effect of preoperative femoral nerve block for preemptive analgesia in elderly patients undergoing total knee arthroplasty under general anesthesia.Methods：86 elderly patients undergoing total knee arthroplasty under general anesthesia were randomly divided into observation group (n=43)and control group(n=43),the observation group received preoperative femoral nerve block and general anesthesia,general anesthesia was used in the control group,postoperative pain visual analogue scale(visual analogue scale,VAS),usage of analgesic drug and adverse reactions were compared in the two groups.Results：24 h after operation,visual Analogue Scale(VAS)score in the observation group was significantly lower than that in the control group(P<0.01).After operation,the time of the usage of analgesic drugs in the observation group for the first time was longer than that in the control group(P<0.01),postoperative within 48h,the frequency of the use of analgesic drugs in the observation group was significantly less than that in control group(P<0.01).48 h after operative,the rate of analgesic drug use was significantly lower than that of the control group (P<0.05).The incidence rate of adverse reactions in the observation group was significantly lower than that in the control group(21/43)(P<0.01).Conclusion：Preoperative femoral nerve block for preemptive analgesia in elderly patients undergoing total knee arthroplasty under general anesthesia,can be more effective for relieving the degree of perioperative pain in patients,reduce the usage of analgesic drug usage,and reduce the incidence of adverse reactions,it is worth to be popularized in clinical treatment.

膝关节骨性关节炎(knee joint osteoarthritis，KOA)已成为困扰中老年患者的一种重要骨关节疾病，该病主要侵犯膝关节的骨、软骨以及滑膜组织等，在临床主要表现为疼痛、畸形等[1]。膝关节功能障碍在上下楼及蹲起等动作时表现明显，对患者的生活质量造成了严重不良影响。全膝关节置换术(Total Knee Arthroplasty，TKA)是KOA重症患者较为彻底且有效的治疗方法。该手术创伤相对较大，术后患者疼痛更为剧烈。而在老年患者中，因腰椎的退变以及围手术期抗凝药物的应用而使得全身麻醉成为较为普遍的选择[2]。术后的剧烈疼痛将对患者的功能锻炼与康复造成不良反应。因此，如何能够对接受全膝关节置换的患者进行良好的镇痛，是保证手术效果及术后功能锻炼的关键所在[3]。为此，我们对43例老年患者实施术前股神经阻滞以达到超前镇痛，现将结果报告如下。……