| 刘彬,耿浩洋,刘文平.老年膝关节置换 126例术后镇痛方式选择及其影响[J].安徽医药,2025,29(8):1545-1550. |
| 老年膝关节置换 126例术后镇痛方式选择及其影响 |
| Selection and influence of analgesia after knee replacement for 126 elderly patients |
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| DOI：10.3969/j.issn.1009-6469.2025.08.012 |
| 中文关键词: 病人自控静脉镇痛 股神经阻滞 罗哌卡因 全膝关节置换术 应激反应 炎症反应 老年人 |
| 英文关键词: Patient controlled intravenous analgesia Femoral nerve block Ropivacaine Total knee replacement Stress re-sponse Inflammatory response Aged |
| 基金项目:河北省医学科学研究课题项目( 20220689) |
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| 中文摘要: |
| 目的探讨并比较静脉自控镇痛(PCIA)与连续股神经阻滞( CFNB)镇痛对老年全膝关节置换术( TKA)后应激及炎症反应的影响。方法纳入 2020年 1月至 2022年 1月河北省沧州中西医结合医院预行 TKA的老年病人 126例，按随机数字表法分为自控组和阻滞组(均 n=63)阻滞组病人接受超声引导下 CFNB镇痛，自控组病人采用 PCIA方案，若病人镇痛效果不满意，补救镇痛时追加 2 mg/kg曲马多。比，较两组应激反应指标水平(术前、术后 1h、术后 24 h)、炎症因子水平(术前、术后 24 h)、镇痛效果、补救镇痛情况、股四头肌肌力评分和膝关节主动屈曲角度(术后 12、24、72 h)、术后情况以及不良反应发生情况。结果与术前比较，阻滞组和自控组术后 1h血清去甲肾上腺素( NE)［( 280.63±35.57)pg/L比(211.82±20.95)pg/L，(299.27±36.44)pg/L比(205.35±24.28)pg/L］、皮质醇［(259.52±36.83)nmol/L比(185.41±18.95)nmol/L，(276.68±39.24)nmol/L比(182.45±21.37)nmol/L］、 C反应蛋白(CRP)［(124.09±20.47)mg/L比(77.58±19.25)mg/L，(132.54±18.38)mg/L比(76.81±15.17)mg/L］水平均显著升高，且阻滞组低于自控组(P<0.05)；与术后 1h比较，阻滞组和自控组术后 24 h血清 NE、皮质醇、 CRP水平均显著降低，且阻滞组低于自控组(P<0.05)。与术前比较，术后 24 h阻滞组和自控组血清白细胞介素 -6(IL-6)、白细胞介素 -8(IL-8)、肿瘤坏死因子 α(TNF-α)水平均显著升高，且阻滞组低于自控组(P<0.05)。术后 2、12、24、72 h阻滞组静息状态、运动状态视觉模拟评分法(VAS)评分均显著低于自控组(P<0.05)。术后 12、24、72 h，两组股四头肌肌力评分、膝关节主动屈曲角度、术后情况比较，均差异无统计学意义(P>0.05)。阻滞组不良反应总发生率显著低于自控组(14.29%比 31.75%)(P<0.05)。结论 CFNB镇痛对老年 TKA术后疼痛的效果优于 PCIA，且病人术后应激及炎症反应也较轻，不影响股四头肌肌力及术后膝关节角度，不良反应发生率低。 |
| 英文摘要: |
| Objective To investigate and compare the impacts of patient-controlled intravenous analgesia (PCIA) and continuous fem-oral nerve block (CFNB) analgesia on stress and inflammatory response after total knee arthroplasty (TKA) in elderly patients.Meth. ods A total of 126 elderly patients who underwent TKA in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicineof Hebei Province from January 2020 to January 2022 were included and grouped into a self-control group and a block group (all n=63) according to the random number table method. The patients in the block group received ultrasound-guided CFNB analgesia, and the pa-tients in the self-control group were treated with PCIA. If the patient was not satisfied with the analgesic effect, 2 mg/kg tramadol shouldbe added to the rescue analgesia. The levels of stress response indicators (preoperative, 1 h, and 24 h after operation), inflammatory fac-tor levels (preoperative, 24 h after operation), analgesic effect, rescue analgesia, quadriceps muscle strength score and active knee flex-ion angle (postoperative 12, 24, 72 h), postoperative situation and adverse reactions were compared between the two groups. Results Compared with before operation, serum norepinephrine (NE) [(280.63±35.57) pg/L vs. (211.82±20.95) pg/L, (299.27±36.44) pg/L vs. (205.35±24.28) pg/L], cortisol (COR) [(259.52±36.83) nmol/L vs. (185.41±18.95) nmol/L, (276.68±39.24) nmol/L vs. (182.45±21.37) nmol/L], and C-reactive protein (CRP) [(124.09±20.47) mg/L vs. (77.58±19.25) mg/L, (132.54±18.38) mg/L vs. (76.81±15.17) mg/L] lev-els in the block group and the self-control group were greatly increased at 1 h after operation, and levels in the block group were signifi-cantly lower than those in the self-control group (P<0.05); compared with 1 h after operation, the serum levels of NE, COR and CRP in the block group and the self-control group were greatly decreased at 24 h after operation, and levels in the block group were significantly lower than those in the self-control group (P<0.05). Compared with before operation, the levels of serum interleukin-6 (IL-6), interleu-kin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in the block group and the self-control group were greatly increased 24 h after opera-tion, and levels in the block group were significantly lower than those in the self-control group (P<0.05). The VAS scores of resting stateand exercise state in the block group at 2, 12, 24, and 72 h after operation were greatly lower than those in the self-control group (P<0.05). At 12, 24, 72 h after operation, there was no significant difference between the two groups in muscle strength score, active kneeflexion angle and postoperative situation of quadriceps femoris (P>0.05). The total incidence of adverse reactions in the block group was greatly lower than that in the self-control group (14.29% vs. 31.75%) (P<0.05).Conclusions CFNB analgesia is more effective thanPCIA on postoperative pain in elderly patients after TKA, and the postoperative stress and inflammatory reactions are also less. Thestrength of quadriceps muscle and the knee joint angle postoperatively are not affected, and the incidence of adverse reactions is low. |
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