持续股神经阻滞对全膝关节置换术后深静脉血栓形成的影响

Effect of continuous femoral nerve block on the deep vein thrombosis after total knee arthroplasty

摘要:

目的：观察持续股神经阻滞对全膝关节置换术（total knee arthroplasty，TKA）后深静脉血栓（deep vein thrombosis，DVT）形成的影响。方法：2011年2月至2013年3月，纳入115例单侧ＴＫＡ置换术患者。随机分为研究组（n=59）、对照组（n=56）。2组患者均在静吸复合全身麻醉下行TKA手术，研究组于手术后给予股神经阻滞自控镇痛（patients controlled nerve analgesia，PCNA），对照组于手术后行曲马多静脉自控镇痛（patients controlled intravenous analgesia，PICA）。检测血浆D-二聚体浓度以及超声探测双下肢深静脉有无血栓形成，观察术后2、6、12、24、48 h和72 h 2组患者疼痛评分（visual analogue scores，VAS）以及术后3 d患者功能锻炼行走距离。结果：术后研究组血浆D-二聚体浓度低于对照组（P=0.000 8；P=0.000；P=0.000）；超声检查发生DVT显示，对照组6例，研究组2例，差异有统计学意义（?字2=4.296，P=0.039）；研究组术后各观察点VAS均低于对照组，下地行走距离均高于对照组（P=0.000；P=0.000；P=0.000）。结论：PCNA相比于静脉自控镇痛对预防TKA术后DVT发生具有更明显的效果，可能与其更好的镇痛效果及促进患者早期功能锻炼有关。

Abstract:

Objective：To investigate the effect of continuous femoral nerve block on the deep vein thrombosis（DVT） in patients under－going total knee arthroplasty（TKA）. Methods：During February 2011 to March 2013，115 patients undergoing TKA were recruited in this study. These patients were assigned randomly into 2 groups：study group（n=59） and control group（n=56）. All these patients received unilateral TKA under intravenous plus inhalation anesthesia. After the surgery，patients in study group were treated with continuous femoral nerve block for the postoperative pain，meanwhile，patients in control group were treated with patients controlled intra－venous analgesia（PICA）. The level of D-dimer in plasma was detected and the ultrasonic detector was applied to estimate the DVT. Visual analogue scores（VAS） at 2，6，12，24，48，72 h after the surgery were recorded. Functional exercise was assessed with the distance of patients’ walk within 3 d after TKA. Results：After the TKA，the plasma level of D-dimer was significantly lower in study group than in control group（P=0.000 8，P=0.000，P=0.000）. The outcomes of the ultrasonic detection showed that 6 out of 56 patients in control group developed DVT after TKA，whereas 2 out of 59 patients in study group developed DVT after TKA（?字2=4.296，P=0.039）. The VAS at each time point was lower in study group than in control group. The distance was longer in study group than in control group（P=0.000，P=0.000，P=0.000）. Conclusions：Continuous femoral nerve block has better effect on DVT after TKA than PICA，which may relate with its better analgesic effect and its promotion of postoperative functional exercise.