髓腔内注射镇痛合剂对人工全髋关节置换术后镇痛的疗效分析

发布时间：2018-03-29 08:58

本文选题：镇痛　切入点：髓腔内注射　出处：《延边大学》2017年硕士论文

【摘要】：目的:分析髓腔内注射镇痛合剂对人工全髋关节置换术(Total Hip Arthroplasty,THA)患者术后镇痛的治疗效果。方法:收集2014年9月-2016年12月间在本院骨外科接受THA治疗的102例患者,分为对照组(A组,53例),常规口服镇痛药物;实验组(B组49例),在常规口服镇痛药物的基础上术中行髓腔内注射镇痛合剂。术后检测血常规,测定血小板(Platelets,PLT)、中性粒细胞计数(Neutrophils,NEUT)、淋巴细胞计数(Lymphocyte Count,LC),计算中性粒细胞与淋巴细胞比值(Neutrophils to Lymphocyte Ratio,NLR)和血小板与淋巴细胞比值(Platelet to Lymphocyte Ratio,PLR),比较两组的测定结果,分析各指标间的相关性,·析NLR与PLR对治疗效果的判定意义。检测两组患者术前术后的C-反应蛋白(C-Reactive Protein,CRP)、D-二聚体(D-Dimmer)、二氧化碳分压(Partial Pressure of Carbon Dioxide,PCO2),记录两组患者术前术后心率、呼吸频率、血压等—般情况。于术后不同时间段(12h、24h、48h、72h,1w、2w)及随访时(1个月、3个月)在静息和活动两种状态下进行VAS评分、髋关节Harris评分,并记录。随访1个月、3个月做Barthel评分;记录术后髋关节活动情况;记录患者手术时间、住院总费用,记录不良反应发生等情况。结果:两组患者术后PLR的ROC曲线:曲线下面积:0.629(P0.05),敏感(sensitivity)0.458,特异度(specificity):0.811,切点值:PLR=194.53。A组患者手术后与手术前的CRP差值、D-Dimmer差值、Pco2差值均显著高于B组,差异具有统计学意义(P0.001);A组患者术后的CRP值、D-Dimmer值、Pco2值均显著高于术前,差异具有统计学意义(P0.001)。两组患者术后12h、24h、48h和72hVAS评分均有统计学差异(P0.05);B组术后Harris评分均较A组高,两组患者术后72h、1w、2w Harris评分,术后随访1个月、3个月Barthel评分均具有统计学差异(P0.05)。B组患者开始主动活动时间均较A组短,各项主动活动时间均具有统计学差异意义(P0.05);术后24h内,两组患者髋关节主、被动状态下屈曲度分别达45°的例数进行比较,差异有统计学意义(P0.05)。A组患者手术后与手术前呼吸频率、心率、血压差值均显著高于B组,差异具有统计学意义(P0.001);A组患者术后呼吸频率、心率、血压均显著高于术前,差异具有统计学意义(P0.001)。发生各项不良反应的例数进行比较,两组患者间差异无统计学意义(P0.05)。结论:采用髓腔内注射镇痛合剂对THA患者术后镇痛治疗,安全可靠,无明显的药物不良反应发生。可有效降低下肢深静脉血栓、冠心病等围手术期并发症的发生率。可有效降低术后疼痛恐惧心理,利于术后康复锻炼。
[Abstract]:Objective: to analyze the effect of intramedullary injection analgesia mixture on postoperative analgesia in patients undergoing total Hip arthroplasty. Methods: 102 patients who received THA in bone surgery from September 2014 to December 2016 were collected. Group A was divided into control group (n = 53), group A (n = 53), group B (n = 49), group B (n = 49) received intramedullary intramedullary analgesic injection on the basis of routine oral analgesic drugs, and blood routine was detected after operation. Platelet count, neutrophil neutrophil count, lymphocyte count, neutrophils to Lymphocyte ratiotrophil (NLR) and platelet to lymphocyte ratio (Platelet to Lymphocyte RatioPLR) were measured, and the results were compared between the two groups. To analyze the correlation between the indexes, to analyze the significance of NLR and PLR in determining the therapeutic effect, to detect the C-reactive protein (C-Reactive protein), C-Reactive protein (CRP), D-Dimmerium, partial Pressure of Carbon dioxide-PCO2, and to record the heart rate and respiratory rate before and after operation in the two groups. Blood pressure and so on. VAS score, Harris score of hip joint were performed at different time after operation (12h / 24h / 48h / 72h / 1w / 2w) and follow-up (1 month, 3 months) respectively, and recorded. Follow up for 1 month, 3 months for Barthel score; Record the hip joint movement after operation, the time of operation, the total cost of hospitalization, Results: the ROC curves of PLR in two groups were as follows: the area under the curve was 0. 629, P 0. 05, sensitivity was 0. 458, specificity was 0. 811, and the cut point value was 194.53.A, the D-Dimmer difference was significantly higher than that in group B, and the difference of D-Dimmer was significantly higher than that in group B (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). There was significant difference in CRP and D-Dimmer and Pco2 in group A (P 0.001), and the difference was statistically significant (P 0.001). The Harris scores in group B were significantly higher than those in group A (P 0.05), and the scores of 72hVAS were significantly higher in group B than in group A at 12 hours after operation. The patients in the two groups were followed up for 1 month at 72 hours and 1 week after operation. The Barthel scores in group B were significantly shorter than those in group A (P 0.05), and the time of active activity in group B was significantly different from that in group A (P 0.05), and within 24 hours after operation, there was no significant difference between the two groups in the time of active activity (P 0.05). There were significant differences in respiratory frequency, heart rate and blood pressure difference between group A and group B after operation and before operation in patients with active and passive hip flexion (45 掳), the difference was significantly higher than that in group B (P 0.05), and the difference between group A and group A was significantly higher than that in group B. The postoperative respiratory frequency, heart rate and blood pressure in group A were significantly higher than those before operation, and the difference was statistically significant (P 0.001). Conclusion: intramedullary analgesia mixture for postoperative analgesia in patients with THA is safe and reliable, no obvious adverse drug reactions occur, and can effectively reduce deep venous thrombosis of lower extremity. The incidence of perioperative complications of coronary heart disease can effectively reduce postoperative pain and fear and is beneficial to postoperative rehabilitation and exercise.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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