氯普鲁卡因股神经阻滞在膝关节置换术后康复锻炼中的应用

目的：探索氯普鲁卡因行股神经阻滞对全膝关节置换术（TKA）患者术后早期关节功能锻炼的影响。方法：选取2017 年9月至2018 年12月在温州医科大学附属第二医院育英儿童医院行单侧TKA术并伴有对侧膝关节炎症状的患者60例，随机分为两组（C组：1%氯普鲁卡因0.2 mL/kg，NS组：0.9%氯化钠溶液0.2 mL/kg）。所有患者于术前行股神经置管，术后48 h开始膝关节功能锻炼，每天3次，共4 d。每次锻炼前10 min予氯普鲁卡因或0.9%氯化钠溶液行股神经阻滞，记录每天第3次锻炼给药前后主动运动时的数字 评分法（NRS）评分、关节活动度（ROM）及术后第7天主动运动时的NRS评分、ROM、康复满意度及美国膝关节协会（AKS）评分。结果：NS组患者术后第3～第6天每天第3次给药前后的ROM和NRS评分差异无统计学意义（P ＞0.05），而C组患者术后第3～第6天每天第3次给药后ROM较给药前明显增大（P ＜0.01），NRS评分明显下降 （P ＜0.01）；C组患者术后第6天给药前ROM、术后第7天ROM和满意度均优于NS组（P ＜0.01）；两组患者术后第7 天的NRS和AKS评分差异无统计学意义（P >0.05）。结论：1%氯普鲁卡因0.2 mL/kg股神经阻滞可减轻TKA患者术后早期康复锻炼时的关节疼痛，从而改善患者术后的关节活动度，提高患者满意度。

Chloroprocaine applied to femoral nerve block and its effect on rehabilitation exercises after total knee arthroplasty

Objective: To explore the application of chloroprocaine given for femoral nerve block and its effect on rehabilitation exercises after total knee arthroplasty. Methods: From September 2017 to December 2018, 60 patients who had unilateral knee surgery with symptoms of the contralateral knee joint were selected in the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University. Patients were randomly divided into two groups receiving 1% chloroprocaine 0.2 mL/kg (group C) or 0.9% sodium chloride solution 0.2 mL/kg (group NS). All patients underwent femoral nerve catheterization before surgery, and began knee functional exercises 48 h after surgery, 3 times a day for a total of 4 days. Drugs were administered to block femoral nerve 10 min before training. The NRS scores, maximum range of motion (ROM) of the third exercise every day before and after administration were recorded, as well as the NRS scores, maximum ROM, the training satisfaction and AKS scores on day 7 after surgery. Results: In group NS, there was no significant difference in ROM and NRS scores before and after the third administration every day on day 3-6 after surgery (P>0.05), but in group C, the ROM after the third administration every day on day 3-6 after surgery increased significantly compared with those before administration (P<0.01), while the NRS scores decreased apparently (P<0.01). ROM of group C on day 6 before administration, ROM on day 7 and training satisfaction were all significantly better than that of group NS(P<0.01). There was no significant difference in NRS and AKS scores between two groups on day 7 after surgery (P>0.05). Conclusion: 1% chloropprocaine 0.2 mL/kg given for femoral nerve block can alleviate the pain caused by early rehabilitation exercises after total knee arthroplasty, and improve the postoperative rangeof joint motion as well as the training satisfaction of the patients.