超声引导下连续性股神经阻滞镇痛在膝关节手术患者中的应用效果及安全性

doi:10.3969/j.issn.1006-6233.2025.11.022

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摘要 目的: 分析膝关节手术中应用超声引导下连续性股神经阻滞(CFB)镇痛的效果及安全性。方法: 研究对象选择为2021年3月—2024年6月医院收治的膝关节损伤且行膝关节手术治疗的患者,103例患者进行简单随机分组(随机数字表法),其中对照组(n=51)采用静脉自控镇痛(PCIA),观察组(n=52)采用超声引导下CFB镇痛,比较两组镇痛情况:视觉模拟疼痛量表评分(VAS)、炎症反应指标:白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、术后谵妄及不良反应发生情况。结果: 观察组术后8h、12h、24h、48h的静息VAS及术后4h、8h、12h、24h、48h的运动VAS低于对照组(P<0.05);两组术后炎症指标水平均升高,但观察组低于对照组(P<0.05);对照组术后第1、2、3天均有患者发生谵妄,观察组仅第2天有患者发生谵妄,两组术后第4、5、6、7天均无患者发生谵妄,观察组术后谵妄总发生率低于对照组术后谵妄总发生率(P<0.05);两组术后膝关节活动度(KSS)评分均较术前上升,观察组术后24h、49h的KSS评分均高于对照组(P<0.05);观察组中共2例(3.85%)患者加用镇痛药物,对照组共10例(19.61%)患者加用镇痛药物,观察组补救镇痛患者数显著少于对照组(χ²=6.214,P=0.013);观察组不良反应总发生率为19.23%,低于对照组的49.02%(P<0.05)。结论: 超声引导下CFB在膝关节手术患者中具有良好的镇痛效果,可抑制炎症反应,减少谵妄及不良反应发生情况,具有良好的临床应用价值。

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关键词 ：膝关节, 股神经阻滞, 镇痛

Abstract：Objective: To analyze the effect and safety of ultrasound-guided continuous femoral nerve block (CFB) for analgesia in knee surgery. Methods: From March 2021 to June 2024, 103 patients with knee injuries who underwent knee surgery in the hospital were selected as the study subjects. They were grouped by random number table method. The control group (n=51) received patient-controlled intravenous analgesia (PCIA), while the observation group (n=52) received ultrasound-guided CFB for analgesia. The two groups were compared on analgesic effect [Visual Analogue Scale (VAS) score for pain], inflammatory response indicators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP)], the incidence of postoperative delirium, and adverse reactions. Results: Compared with the control group, the observation group showed reductions in VAS in resting state at 8h, 12h, 24h, and 48 h after surgery and VAS in the motion state at 4h, 8h, 12h, 24h, and 48h after surgery (P<0.05). After surgery, the levels of inflammatory markers in both groups increased, and the levels were lower in observation group (P<0.05). Delirium was observed in the control group on the 1st, 2nd, and 3rd day after surgery, and in the observation group on the 2nd day. No delirium was observed in the two groups on the 4th, 5th, 6th, and 7th day after surgery. The total incidence of delirium was lower in the observation group (P<0.05). Both groups showed an increase in knee range of motion (KSS) scores after surgery. At 24h and 49h after surgery, the observation group had higher KSS scores than the control group (P<0.05). Two (3.85%) patients in the observation group and ten (19.61%) in the control group received additional use of analgesics. There were fewer patients receiving remedial analgesia in the observation group compared with the control group (χ2=6.214, P=0.013). The total incidence of adverse reactions was 19.23% in the observation group, lower than 49.02% in the control group (P<0.05). Conclusion: Ultrasound-guided CFB can achieve a good analgesic effect in patients undergoing knee surgery. It can inhibit inflammatory response and reduce the occurrence of delirium and adverse reactions.

Key words： Knee joint Femoral nerve block Analgesia

基金资助:安徽省医学会急诊医学会分会2021年急诊临床研究项目,(编号:Ky2021018)

通讯作者: 徐湘盛

引用本文:

沈玉秀, 徐湘盛, 张忠华, 陆欢, 徐小宁. 超声引导下连续性股神经阻滞镇痛在膝关节手术患者中的应用效果及安全性[J]. 河北医学, 2025, 31(11): 1891-1895.
SHEN Yuxiu, XU Xiangsheng, et al. Application Effect and Safety of Ultrasound-Guided Continuous Femoral Nerve Block for Analgesia in Patients Undergoing Knee Surgery. HeBei Med, 2025, 31(11): 1891-1895.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.11.022 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I11/1891

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