曾德亮,陈静,张笃文,冯亚平,彭晶,贺纯静
ZENG Deliang,CHEN Jing,ZHANG Duwen,FENG Yaping,PENG jing,HE Chunjing

• 1:贵州省人民医院麻醉科

摘要(Abstract)：

目的:探讨连续股神经阻滞术后镇痛(CFNB)对老年人全膝关节置换术(TKA)后早期认知功能的影响。方法:选择择期行单侧TKA的老年患者60例,随机分为两组(n=30),分别于术毕接受静脉自控镇痛(PCIA组)和连续股神经阻滞镇痛(CFNB组),记录术后6 h、24 h、48 h静息状态和术后24 h、48 h持续被动运动训练时VAS疼痛评分、吗啡消耗量以及不良反应(嗜睡、恶心呕吐及瘙痒)的发生率,于术前第1天、术后第1、3、7天对患者采用简易智力状态检查法(MMSE)判断认知功能障碍(POCD)发生率。结果:CFNB组各时间点的静息和被动运动训练时VAS疼痛评分、吗啡消耗量及不良反应发生率均低于PCIA组(P<0.05),术后第1天和第3天CFNB组MMSE评分高于PCIA组;POCD发生率低于PCIA组(P<0.05),术后第7天两组MMSE评分及POCD发生率无明显差异。结论:TKA后CFNB镇痛能够提供良好的镇痛效果,不良反应发生率低,可以减少吗啡消耗量,降低术后早期POCD的发生率。
Objective: To investigate the effects of continuous femoral nerve block(CFNB) analgesia on early stage postoperative cognitive dysfunction( POCD) total knee arthroplasty( TKA) senior patients. Method: Selecting sixty TKA ASA I or Ⅱ patients of both genders,randomly divided into 2groups(n = 30 each); accepting patient controlled intravenous analgesia(PCIA group) and continuous femoral nerve block analgesia( CFNB group) after surgery respectively. Recording resting state in postoperative 6 h,24 h,48 h,VAS pain scale from continuous passive movement training,morphine consumption,and incidence rate of adverse reaction(somnolence,nausea and vomiting and itching)in postoperative 24 h,48 h. Assessing postoperative cognitive dysfunction(POCD) by using mini-mental state examination(MMSE) the day before operation,and first,third and seventh day after operation.Results: Statistics of resting state,VAS pain scale from continuous passive movement training,morphine consumption,and incidence rate of adverse reaction of CFNB group in each time point were lower than PCIA group. The morphine consumption,and the incidence of somnolence,nausea and vomiting and itching were decreased in CFNB group than in PCIA group( P < 0. 05). The MMSE evaluation of CFNB group were better than PCIA group,and the incidence rate of postoperative cognitive dysfunction(POCD) of CFNB group was lower on first and third postoperative day;MMSE evaluation and incidence rate of POCD exhibited no significant differences on seventh postoperative day. Conclusion:CFNB analgesia can provide a potent analgesia effect with low incidence rate of adverse reactions,reducing morphine consumption,and decrease of incidence rate of postoperative early stage POCD.

关键词(KeyWords)： 外科手术;膝关节;神经传导阻滞;股神经;疼痛;认知障碍
surgical procedures,operative;knee joint;nerve block;femoral nerve;pain;cognition disorders

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 曾德亮,陈静,张笃文,冯亚平,彭晶,贺纯静
ZENG Deliang,CHEN Jing,ZHANG Duwen,FENG Yaping,PENG jing,HE Chunjing

DOI: 10.19367/j.cnki.1000-2707.2014.03.023

参考文献(References)：

• [1]Monk TG,Weidon BC,Carvan CW,et al.Preditors of cognitive dysfunction after majornon cardiac surgery[J].Anesthesiology,2008(1):18-30.
• [2]Heyer EJ,Sharma R,Winfree CJ,et al.Several psin confounds neuropsychological tese performance[J].Clin EXP Neuropsychol,2000(22):633-639.
• [3]李丽萍,江晓,葛衡江.术后疼痛对老年患者术后早期认知功能的影响[J].重庆医学,2009(14):106-108.
• [4]Newman S,Stygall J,Hirani S,et al.Postoperative cognitive dysfunction after noncardiac surgaery:systematic review[J].Anesthesiology,2007(3):572-590.
• [5]Berend KR,Lombardi AV,Mallory TH.Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients[J].Surg Technol Int,2004(13):239-247.
• [6]李东文,徐燕,吴海山.全膝关节置换术后多模式围手术期疼痛控制方案在镇痛中的作用评价[J].中国组织工程研究与临床康复,2007(36):7223-7226.
• [7]Reinhardt KR,Duggal S,Umunna BP,et al.Intraarticular analgesia versus epidural plus femoral nerve block after TKA:A randomized,double-blind trial[J].Clin Orthop Relat Res,2014(5):1400-1408.
• [8]Wu JW,Wong YC.Elective unilateral total knee replacement using continuous femoral nerve blockade versus conventional patient-controlled analgesia:peri-operative patient management based on a multidisciplinary pathway[J].Hong Kong Med J,2014(1):45-51.
• [9]Dickerson BC.Functional magnetic resonance imaging of cholinergic modulation in mild cognitive impairment[J].Neuropsychiatry,2006(3):299-306.
• [10]Wang Y,Sands LP,Vaurio L,et al.The effects of postoperative pain and its management on postoperative cognitive dysfunction[J].American Journal of Geriatric Psychiatry,2007(1):50-59.

文章评论(Comment)：