连续股神经阻滞与静脉自控镇痛对全膝关节置换术后患者凝血功能的影响

目的:比较连续股神经阻滞(CFNB)与静脉自控镇痛(PCIA)在全膝关节置换术中的应用效果及对患者凝血功能的影响。方法:选取2014年1月至2015年12月间我院行单侧全膝关节置换术的患者80例,按照随机数字表法分为CFNB组和PCIA组,每组各40例,两组患者分别接受CFNB和PCIA治疗。观察两组患者术后6 h、12 h、24 h、48 h视觉模拟疼痛评分(VAS),两组患者分别于麻醉前(T1)、术毕(T2)、术后1 d(T3)、术后2 d(T4)进行血栓弹力图检查,观察两组凝血功能变化。并于术后随访1年,比较两组患者膝关节功能。结果:术后6 h、12 h、24 h、48 h CFNB组患者VAS评分显著低于PCIA组患者(P0.05)。T2、T3、T4时点CFNB组患者凝血反应时间(R)、血凝块形成时间(K)较T1升高,血凝块聚合形成速率(α角)、血凝块最大振幅(MA)较T1降低,PCIA组患者R、K较T1降低,α角、MA较T1升高,T2、T3、T4时点CFNB组患者R、K高于PCIA组患者,α角、MA低于PCIA组患者,差异均有统计学意义(P0.05)。两组患者术后均完成1年的随访,两组患者KSS评分、膝关节最大屈曲度、膝关节最大伸直度比较无统计学差异(P0.05)。结论:CFNB对于全膝关节置换术术后患者镇痛效果优于PCIA,有利于改善患者凝血功能,不影响术后患者膝关节功能的恢复。

Effects of Continuous Femoral Nerve Block and Intravenous Patient-controlled Analgesia on Coagulation Function in Patients after Total Knee Arthroplasty

ABSTRACT Objective: To compare the effects of continuous femoral nerve block (CFNB) and intravenous patient-controlled analgesia (PCIA) in total knee arthroplasty (TKA) and the effects on coagulation function. Methods: Selected 80 patients who were treated with unilateral total knee arthroplasty in our hospital from January 2014 to December 2015, and they were divided into CFNB group (n=40) and PCIA group (n=40) according to the random number table method. Patients of two groups were treated with CFNB and PCIA, respectively. The visual analogue pain score (VAS) of patients in two groups were observed at 6 h, 12 h, 24 h and 48 h after operation. Thrombelastogram of patients in two groups were inspected before anesthesia (T1), after operation (T2), 1 d after operation (T3), 2 d after operation (T4), and the changes of coagulation function in the two groups were observed. The joint function was compared between the two groups after the follow-up of 1 years. Results: The VAS scores of CFNB group were significantly lower than that of PCIA group at 6 h, 12 h, 24 h, 48 h after operation(P<0.05). At T2, T3 and T4, the coagulation time (R) and blood clot formation time (K) of CFNB group were higher than those at T1, the rate of clot formation (alpha angle) and the maximum amplitude of blood clot (MA) were lower than that at T1, R, K in PCIA group were lower than at T1, alpha angle and MA were higher than those at T1, R and K of CFNB group were significantly higher than that of PCIA group at T2, T3, T4, while alpha angle and MA were lower than those in PCIA group, the differences were statistically significant (P<0.05). Patients in two groups were followed up for a total of 1 years, and the KSS score, maximum flexion and knee extension of the two groups were not significantly difference(P>0.05). Conclusion: CFNB is better than PCIA in patients after total knee arthroplasty, which is helpful to improve the coagulation function of patients and does not affect the recovery of knee function after operation.