全膝关节置换镇痛:加巴喷丁联合连续股神经阻滞的应用效果

发布时间：2018-02-14 12:14

本文关键词：假体植入关节成形术置换膝股神经镇痛组织工程骨科植入物人工假体加巴喷丁连续股神经阻滞全膝关节置换围手术期镇痛效果生活质量膝关节活动度　出处：《中国组织工程研究》2015年44期 　论文类型：期刊论文

【摘要】：背景:传统的镇痛方法虽然能够缓解全膝关节置换患者疼痛,但是预后较差,药物依赖性较强。因此,临床上研究全膝关节置换围手术期镇痛药物具有重要的意义。目的:探讨加巴喷丁联合连续股神经阻滞对于全膝关节置换的镇痛效果。方法:从内蒙古医科大学附属医院骨科2013年10月至2014年10月收治的因膝关节骨关节炎行全膝关节置换的48例患者进行研究,均采用全身麻醉方式,且麻醉前行股神经阻滞,置换后连接镇痛泵。按照随机数字表法将患者分为两组,对照组采用多模式镇痛,试验组采用加巴喷丁联合连续股神经阻滞镇痛。采用静息、活动目测类比评分对患者疼痛程度进行评分,观察患者置换后生活质量、膝关节活动度及并发症等相关指标。结果与结论:两组置换前静息痛和活动痛差异无显著性意义(P0.05);两组置换后疼痛随着时间延长目测类比评分降低,试验组置换后1,3,7 d以及1个月静息痛和活动痛目测类比评分均显著低于对照组(P0.05)。试验组置换后3-7 d膝关节活动度均显著大于对照组,差异有显著性意义(P0.05)。随访12个月,试验组日常生活能力量表(ADL)评分、躯体功能评分、心理功能评分及社会功能评分均显著高于对照组(P0.05)。试验组并发症发生率显著低于对照组(17%,46%,P0.05)。提示在全膝关节置换围手术期实施加巴喷丁联合连续股神经阻滞镇痛效果理想,尤其是48 h内急性疼痛者,能够促进患者膝关节功能早期恢复,且不良反应少。
[Abstract]:Background: although traditional analgesic methods can relieve pain in patients with total knee arthroplasty, the prognosis is poor and drug dependence is strong. It is important to study the analgesic drugs in perioperative period of total knee arthroplasty. Objective: to study the analgesic effect of gabapentin combined with continuous femoral nerve block on total knee arthroplasty. Methods: from Inner Mongolia Medical University. From October 2013 to October 2014, 48 patients with knee osteoarthritis underwent total knee arthroplasty. The patients were divided into two groups according to the method of random number table, the control group was treated with multi-mode analgesia, and the patients in the control group were treated with multi-mode analgesia. The experimental group was treated with gabapentin combined with continuous femoral nerve block analgesia. The patients' pain degree was evaluated by resting and visual analogue score, and the quality of life was observed after replacement. Results and conclusion: there was no significant difference in resting pain and active pain between the two groups before replacement (P 0.05). The visual analogue scores of resting pain and active pain in the trial group were significantly lower than those in the control group at 1: 3 ~ 7 days and 1 month after replacement. The knee joint motion in the trial group was significantly higher than that in the control group at 3 to 7 days after replacement, and there was a significant difference between the two groups. 12 months follow-up showed that the knee joint motion in the trial group was significantly higher than that in the control group. ADL score and somatic function score in the test group; The scores of psychological function and social function were significantly higher than those of the control group (P 0.05). The incidence of complications in the experimental group was significantly lower than that in the control group (P 0.05). It suggested that the analgesic effect of gabapentin combined with continuous femoral nerve block during the perioperative period of total knee arthroplasty was ideal. Especially in patients with acute pain within 48 hours, the early recovery of knee joint function was promoted, and the adverse reactions were less.
【作者单位】：内蒙古医科大学附属医院麻醉科;内蒙古医科大学附属医院骨科;
【基金】：内蒙古医科大学青年创新基金项目(YKD2012QNCX017)~~
【分类号】：R614

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