作　　者： (张禄锴）; (马剑雄）; (匡明杰）; (卢斌）; (王颖）; (李风波）; (赵杰）; (范峥睿）; (马信龙）;

机构地区： 天津中医药大学研究生院

出　　处： 《中华创伤杂志》 2017年第9期792-800,共9页

摘　　要： 目的评价全膝关节置换（TKA）围术期应用持续股神经阻滞（CFNB）或患者自控镇痛（PCA）方式缓解术后疼痛的有效性，为手术医师在围术期镇痛方式的选择提供依据。方法检索Cochrane Library、Embase、PubMed和万方、维普及中国知网等数据库有关在TKA围术期应用CFNB和PCA的临床随机对照试验（RCT），根据Cochrane系统评价手册对纳入的文献进行评分，使用RevMan5．3软件进行Meta分析，比较两种镇痛方式在术后视觉模拟评分（VAS）、美国特种外科医院（HSS）膝关节评分、麦考斯特大学骨关节炎指数（WOMAC）评分、患者满意度、并发症发生（恶心、呕吐、头晕、嗜睡、皮肤瘙痒等）方面差异有无统计学意义。结果最终纳入24篇文献，其中英文文献13篇，中文文献11篇，纳入患者1896例，使用CFNB946例，使用PCA950例。合并结果显示CFNB可降低术后制动状态下VAS（MD=-1．28，95％CI-1．56，-1．00，P〈0．05），运动状态下VAS（MD=-0．98，95％CI-1．38，-0．58，P〈0．05），提高术后HSS膝关节评分（MD=2．13，95％CI 0．12，4．14，P〈0．05），降低WOMAC（MD=-0．97，95％CI-1．83，-0．11，P〈0．05），提高患者的满意度（RR=1．27，95％CI 1．10，1．46，P〈0．05），同时降低恶心、呕吐、头晕、嗜睡、皮肤瘙痒等并发症发生（RR：0．32，95％C10．24，0．43，P〈0．05）。结论与PCA相比，TKA围术期使用CFNB镇痛可降低术后疼痛，提高术后膝关节功能评分，增加患者对手术的满意度，同时降低术后并发症的发生率。 Objective To evaluate the efficacy and safety of continuous femoral nerve block （CFNB） versus patient controlled analgesia （PCA） for analgesia in primary total knee arthroplasty （TKA） through a Meta-analysis. Methods All randomized controlled trials （RCTs） which compared about the efficacy and safety of CFNB versus PCA for analgesia in primary TKA, were searched from Cochrane Library, Embase, PubMed, CBM, VIP, Wang Fang database and CNKI. At the same time, conference papers were identified manually. A quality assessment of the included literature was evaluated by Cocbrane system evaluation manually. Revman 5.3 software was used for the Meta-analysis to compare visual analogue scale （VAS）, hospital for special surgery knee score （HSS）, western Ontario and McMaster university of orthopedic index （WOMAC）, patient satisfactory degree, and incidences of complications （ nausea, vomit, dizziness, somnolence, itch of skin, etc）. Results Twenty-four RCTs involving 1896 patients were identified including CFNB （946 cases） and PCA （950 cases） application of TKA. The pooled results illustrated that CFNB could reduce VAS in rest （MD = - 1.28,95% CI - 1.56,- 1.00, P 〈 0.05 ） and VAS in movement （ MD = - 0.98,95% CI - 1.38, - 0.58, P 〈 0.05 ） ,increase HSS （MD =2.13, 95% CI 0.12, 4.14, P 〈0.05） ,reduce WOMAC（MD = -0.97,95% CI- 1.83, -0.11, P 〈0.05）, increase patient satisfactory degree （RR = 1.27,95% CI 1.10,1.46,P 〈0.05） and at the same time reduce the incidences of nausea, vomit, dizziness, somnolence and itch of skin （RR = 0.32,95% CI 0. 24,0.43, P 〈 0.05 ）. Conclusion Compared with PCA, CFNB analgesia can reduce VAS, WOMAC score, improve the postoperative HSS and patient satisfaction degree, and decrease the risk of complications.

关 键 词： 关节成形术 置换 膝 随机对照试验 镇痛 分析