股神经阻滞联合帕瑞昔布静注在老年膝关节置换术后的镇痛效果研究

摘要

目的 探讨老年患者膝关节置换术后采用帕瑞昔布静注联合股神经阻滞镇痛的效果及康复意义.方法 选择本院老年膝关节置换术患者45例,随机分为研究组与对照组,对照组患者术后通过股神经阻滞导管注入罗哌卡因25 mL镇痛,每天3次,持续3 d;研究组患者在对照组股神经阻滞的基础上,手术结束前30 min及术后12、24、48 h静脉注射帕瑞昔布40 mg.记录两组患者术后静态、动态VAS评分,评价患者手术前后膝关节功能,并统计治疗不良反应情况.结果 两组患者术后膝关节功能均明显提高,但研究组术后1、2、3 d的膝关节HSS评分明显高于对照组,差异有统计学意义(t=4.357、5.418、9.379,P<0.05或P<0.01).研究组术后VAS评分均明显低于对照组,差异有统计学意义(静态t=8.714、6.572、10.165、6.429、4.981,P<0.05或P<0.01;动态t=8.032、9.743、8.169、7.925,P<0.05).两组安全性均较好,未出现明显并发症.结论 老年患者膝关节置换术后采用帕瑞昔布静注联合股神经阻滞镇痛效果显著,间接促进了患者膝关节功能的康复.%Objective To investigate the effects and rehabilitation significance of intravenous injection of Parecoxib combined with femoral nerve block after total knee arthroplasty of elderly patients. Methods 45 cases of elderly patients with knee replacement surgery in our hospital were selected and randomly divided into the study group and the control group. Patients of the control group were given the femoral nerve block with Ropivacaine 25 mL, 3 times a day for 3 d treatment. Patients of the study group were given intravenous injection of 40 mg Parecoxib treatment at 30 min end of surgery and 12, 24 and 48 h after surgery on the basis of the control group. Statical and dynamic VAS scores were recorded, and the knee function was evaluated in both groups before and after surgery, and the adverse reactions were statistical. Results The patients' knee function improved significantly of the two group after surgery, but 1, 2, 3 d after operation, HSS score of the study group was significantly higher than those of the control group , the differences were statistically significant (t = 4.357, 5.418, 9.379, P < 0.05 or P < 0.01). The VAS scores of the study group were significantly lower than those of the control group , the differences were statistically significant (statical scores: t = 8.714, 6.572, 10.165, 6.429, 4.981, P < 0.05 or P < 0.01; dynamic scores: t = 8.032, 9.743, 8.169, 7.925, P < 0.05). The security of the two groups was all good, and had no significant complications. Conclusion The effect of femoral nerve block combined with intravenous injection of Parecoxib application after total knee arthroplasty of elderly patients is good, which also indirectly contributes to the rehabilitation of knee function.