膝关节置换后镇痛方案的选择与安全性评价

发布时间：2018-06-07 05:51

本文选题：组织工程 + 膝关节　；参考：《中国组织工程研究》2015年39期

【摘要】：背景:积极的人工全膝关节置换极大改善了膝关节退行性疾病患者的生活质量,但围置换期急性疼痛广泛存在,增加了并发症的发生概率,阻碍了患者的康复锻炼,因此围置换期疼痛处理成为当前膝关节置换的重要课题。目的:观察比较包括帕瑞昔布钠超前镇痛、关节周围镇痛、帕瑞昔布钠超前镇痛与关节周围镇痛联合等方案在患者膝关节置换后镇痛中的疗效及安全性,探索合理有效的镇痛方案。方法:随机选择江苏省徐州市中心医院在2012年5月至2014年12月收治的60例膝关节置换患者,通过随机数表法将其分为帕瑞昔布钠超前镇痛组、关节周围镇痛组、帕瑞昔布钠超前镇痛+关节周围镇痛组、空白对照组,每组15例,在膝关节置换中对患者实施不同的镇痛方案。结果与结论:置换后6,12,24,36 h,与其他3组比较,帕瑞昔布钠超前镇痛+关节周围镇痛组各时间段的静息痛、活动痛疼痛评分及镇痛药物用量均显著降低(P0.05),置换后麻醉剂的使用时间间隔明显长于其他3组(P0.05)。置换后3 d,与其他3组比较,内帕瑞昔布钠超前镇痛+关节周围镇痛组患者置换后的主动抬腿时间、主动屈膝90°时间显著缩短(P0.05),而膝关节活动度较好。帕瑞昔布钠超前镇痛+关节周围镇痛组患者在3组中不良反应发生率最低(P0.05)。结果提示帕瑞昔布钠联合关节周围镇痛是一种安全可行的镇痛方案,能显著减少膝关节置换后疼痛,减少麻醉用量,患者置换后不良反应降低,有助于改善患者的关节活动度并促进患者早期康复。
[Abstract]:Background: active total knee arthroplasty greatly improves the quality of life of patients with knee joint degenerative diseases, but acute pain is widespread in peri-replacement period, which increases the probability of complications and hinders the rehabilitation of patients. Therefore, perioperative pain management has become an important issue in knee arthroplasty. Objective: to compare the efficacy and safety of preemptive analgesia with paroxib sodium, periarticular analgesia, preemptive analgesia with paroxib sodium and periarticular analgesia in patients with knee arthroplasty. To explore a reasonable and effective analgesic scheme. Methods: sixty patients with knee replacement were randomly selected from Xuzhou Central Hospital of Jiangsu Province from May 2012 to December 2014. The patients were randomly divided into two groups: paroxib sodium preemptive analgesia group and periarticular analgesia group. The periarticular analgesia group (n = 15) and control group (n = 15) were treated with different analgesic schemes during knee arthroplasty. Results and conclusion: compared with the other three groups, preemptive analgesia of pericyclob sodium was performed in the periarticular analgesia group at every time period. The scores of active pain and the dosage of analgesic drugs were significantly lower than those of the other three groups. The time interval of anesthetic use after replacement was significantly longer than that of the other three groups. 3 days after replacement, compared with the other three groups, the time of active leg lift and 90 掳flexion of patients with periarticular analgesia after replacement were significantly shortened and the range of knee motion was better than that of the other three groups. Paroxib sodium preemptive analgesia group had the lowest incidence of adverse reactions in the three groups. The results suggest that paroxib sodium combined with periarticular analgesia is a safe and feasible analgesic scheme, which can significantly reduce pain after knee arthroplasty, reduce the amount of anesthesia, and decrease the adverse reactions after replacement. It is helpful to improve the patient's joint motion and promote the patient's early recovery.
【作者单位】：江苏省徐州市中心医院麻醉科;
【分类号】：R614

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