目的 比较胫骨平台骨折患者术后不同镇痛方法的镇痛效果。方法 将90例胫骨平台骨折手术患者根据术后镇痛方式分为股神经阻滞组(F组)、坐骨神经阻滞组(S组)和静脉术后镇痛组(V组),每组30例,3组均采用腰-硬联合麻醉。F组术毕利用神经刺激器在股神经周围置入导管;S组术毕利用神经刺激器在坐骨神经周围置入导管用于术后镇痛,两组镇痛泵设置:0.2%罗哌卡因250 ml,背景剂量5 ml/h,单次追加剂量5 ml,锁定时间30 min,持续至术后48 h;V组术后给予持续静脉自控镇痛48 h。VAS(视觉模拟疼痛评分)高于4分即给予补救镇痛。观察并记录术后4、8、12、24、36、48 h的静息状态下VAS,术后24、48 h的用药量及患者自控按压次数,患者镇痛满意度,补救镇痛情况,不良反应和凝血功能等。结果 F组、S组术后8、12、24、36 h静息状态VAS均明显低于V组,差异有统计学意义(P＜0.05),术后24、48 h F组的用药剂量分别为(133.9±10.7)ml、(169.3±13.4)ml;S组的用药剂量为(124.6±11.6)ml、(155.7±12.9)ml,分别与V组的用药剂量(172.1±15.2)ml、(233.4±14.1)ml进行对比,差异有统计学意义(P＜0.05);F组、S组术后24、48 h的按压次数分别与V组相比,差异有统计学意义(P＜0.05)。结论 胫骨平台骨折术后持续神经阻滞镇痛效果优于静脉镇痛,坐骨神经阻滞镇痛优于股神经阻滞,但差异无显著性意义。

Objective To compare the different effects of the three analgesic Methods in surgical patients with fracture of tibial plateau. Methods Ninety surgical patients with fracture of tibial plateau in Beijing Jishuitan Hospital were randomly divided into three groups: continuous femoral nerve block group (group F), continuous sciatic nerve block group (group S) and continuous intravenous analgesia group (group V). All anesthesia Methods were combined with spinal-epidural anesthesia. In group F and group S, the catheter for nerve block was respectively placed after operation and analgesic Methods in two groups, including analgesic total volume of 0.2% ropivacaine, basic doses of 5 ml/h, single adding dose of 5 ml and locking time of 30 minutes. In group V, 1 μg/ml sufentanil 250 ml, 3 ml/h, 3 ml and 15 minutes were corresponding Methods with group F and group S. For visual analogue scale (VAS) above 4, 50 mg pethidine acting as remedial analgesic drug was given. VAS scores in the three groups were compared at 4 h, 8 h, 12 h, 24 h, 36 h, 48 h after operation. The times of adding, total doses in 24 h and 48 h, the satisfaction with pain management, complications and coagulation function were recorded. Results The VAS scores in group F and group S were significantly lower than in group V, the difference was statistically significantly different (P＜0.05). After 24 h, 48 h, dosages in Group F were (133.9±10.7) ml, (169.3±13.4) ml; (124.6±11.6) ml, (15.57±12.9) ml dosage in group S, respectively with the group V, the dosage of (172.1±15.2) ml, (233.4±14.1) ml were compared, the difference was statistically significant (P＜0.05). The pressing times in Group F and Group S after operation 24 h and 48 h were compared with that in Group V, the difference was statistically significantly different (P＜0.05). Conclusions Analgesic effect of the nerve block has an advantage over that of intravenous anesthesia. The effect of sciatic nerve block is better than that of femoral nerve block.