阿普唑仑治疗焦虑抑郁患者全膝关节置换后疼痛的安全有效性

发布时间：2018-02-26 17:36

本文关键词： 关节成形术置换膝阿普唑仑疼痛焦虑抑郁组织工程骨科植入物人工假体全膝关节置换围手术期疼痛　出处：《中国组织工程研究》2017年07期 　论文类型：期刊论文

【摘要】：背景:心理因素影响全膝关节置换后患者疼痛程度,干预围手术期心理状态对置换后疼痛以及关节功能的影响尚未见大量报道。目的:观察阿普唑仑干预全膝关节置换前具有焦虑抑郁状态患者的安全性和有效性。方法:选择61例单侧全膝关节置换前存在焦虑抑郁状态的患者,随机分为2组,术前2周干预组予以阿普唑仑片,对照组予以安慰剂。收集基线资料、手术相关资料,术前汉密尔顿评分和Beck抑郁量表评估焦虑抑郁状态变化,术后评估2组患者各时间点静息和活动时的疼痛评分,统计术后非类固醇镇痛药物和静脉自控镇痛泵使用情况,ELISA法检测外周血神经递质,利用相关量表评估关节置换后近中期关节功能,统计患者满意度和住院相关指标,检测药物不良反应。结果与结论:(1)应用阿普唑仑后干预组焦虑抑郁状态有显著改善;干预后2周干预组外周血5-羟色胺和γ-氨基丁酸水平上升;(2)术后12 h、1 d、2 d、3 d、5 d、7 d时干预组静息疼痛目测类比评分显著低于对照组(P0.05);术后12 h、1 d、2 d、3 d、5 d时干预组运动疼痛目测类比评分显著低于对照组(P0.05);(3)干预组镇痛泵及镇痛药物使用均显著少于对照组,镇痛药物使用剂量与术前焦虑抑郁状态具有相关性;(4)2组术后西安大略-麦克马斯特大学骨关节炎指数和美国膝关节协会评分差异无显著性意义;(5)全膝关节置换后干预组满意度、睡眠指数、住院总时长等指标优于对照组。用药期间未见明显不良反应;(6)结果提示,对于全膝关节置换前诊断为焦虑抑郁状态的患者,置换前予以阿普唑仑干预可以缓解焦虑抑郁,改善围手术期静息和运动疼痛,减少术后镇痛药物的使用,增加患者满意度。
[Abstract]:Background: psychological factors affect the degree of pain after total knee arthroplasty. The effect of intervention on postoperative pain and joint function has not been reported. Objective: to observe the safety and efficacy of alprazolam in patients with anxiety and depression before total knee arthroplasty. Methods: 61 patients with anxiety and depression before unilateral total knee arthroplasty were selected. The intervention group was given alprazolam tablets 2 weeks before operation, and the control group was given placebo. The baseline data, operative data, preoperative Hamilton score and Beck depression scale were collected to evaluate the changes of anxiety and depression state. After operation, the pain scores at rest and activity were evaluated, and the use of non-steroidal analgesic drugs and intravenous self-controlled analgesic pump were analyzed. Peripheral blood neurotransmitters were detected by Elisa. The joint function after joint replacement was evaluated by correlation scale, patient satisfaction and hospital related indexes were counted, and adverse drug reactions were detected. Results and conclusion: 1) the anxiety and depression state of intervention group after alprazolam was significantly improved. The visual analogue scores of 5-hydroxytryptamine and gamma-aminobutyric acid in peripheral blood of the intervention group were significantly lower than that of the control group at 7 days after operation at 12 h, 1 day, 2 days, 3 days and 5 days, and 12 hours after operation at 1 day, 2 days and 3 days and 5 days after operation, the visual analogue scores of resting pain in the intervention group were significantly lower than those in the control group (P < 0.05). The visual analogue score of motility pain in the intervention group was significantly lower than that in the control group (P < 0.05) the analgesic pump and the analgesic drug use in the intervention group were significantly lower than those in the control group. There was no significant difference in the osteoarthritis index of Western Ontario McMaster University and the American knee Association score between the two groups after total knee arthroplasty (5) the satisfaction degree of intervention group after total knee arthroplasty. Sleep index and total length of stay were better than those in the control group. No significant adverse reactions were observed during the treatment. The results suggested that patients with anxiety and depression were diagnosed as anxiety and depression before total knee arthroplasty. Alprazolam intervention before replacement can relieve anxiety and depression, improve rest and exercise pain during perioperative period, reduce the use of postoperative analgesic drugs, and increase patient satisfaction.
【作者单位】：西南医科大学护理学院;四川射洪县中医院手术室;四川射洪县中医院骨科;西南医科大学附属医院胃肠外科;
【基金】：四川省射洪县中医院的支持
【分类号】：R749;R687.4

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