硬膜外镇痛泵联合鸡尾酒疗法对膝关节置换术后镇痛效果的临床研究

发布时间：2018-01-26 15:04

本文关键词： 骨性关节炎硬膜外镇痛泵鸡尾酒疗法膝关节置换术术后镇痛　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:随着经济社会的发展,人口老龄化的到来,越来越多的老年人患有骨性关节炎。骨性关节炎是一种退行性病变,由于年龄、肥胖、劳损、外伤等多种因素引起的关节软骨退化损伤、关节边缘和软骨下骨反应性增生。临床表现为缓慢发展的关节疼痛、压痛、僵硬、关节肿胀、活动受限和关节畸形等。目前疾病中后期以人工膝关节置换术(TKA,Total knee arthroplasty)为主,也是目前治疗骨性关节炎最有效的手段,能够起到缓解疼痛、纠正关节畸形、恢复运动功能等目的,因而备受老年患者所青睐。然而,由于骨性关节炎患者年龄普遍较大,且TKA术后疼痛因素众多,术后疼痛影响患者满意度及关节功能康复。因此,术后疼痛管理成为不可回避的问题。目前临床上有众多镇痛方案,但是尚无最理想的治疗方案,本文通过回顾性研究,对硬膜外镇痛泵联合鸡尾酒疗法在初次人工膝关节置换术后镇痛效果进行研究。目的:TKA围手术期镇痛方法较多,包括神经阻滞,口服药物,自控镇痛泵等。本文通过术中在膝关节周围软组织内注射混合镇痛药物(鸡尾酒疗法)及术后放置硬膜外镇痛泵联合镇痛来控制膝关节置换术后的疼痛,减少患者不良反应,促进患者早期锻炼膝关节,提高膝关节置换术治疗效果及患者满意度。方法:选取60例行膝关节置换术治疗的骨关节炎患者,按照随机分配原则分为3组,每组患者20名。A组患者术中膝关节周围软组织注射混合镇痛药物及术后放置硬膜外镇痛泵;B组患者只在术中关节周围软组织注射混合镇痛药物药物;C组只在术后放置硬膜外镇痛泵。观察3组患者术后疼痛视觉模拟评分(VAS)、伤口感染、延期愈合及组织坏死并发症。结果:三组患者术后静息痛VAS评分、活动痛VAS评分相比较,差异具有统计学意义(P0.05)。静息痛评分术后2h,4h,8h,12h,24h,36h,48h A组(联合组)分数均低于B组和C组(P0.05);活动痛评分术后6h,12h,24h,36h,2d,3d,5d患者分数比较,A组分数也均低于B组和C组(P0.05)。无论何种镇痛方式,患者静息痛在术后24h达到最高峰,活动痛在术后36h达到最高峰。三组患者在术后切口感染、延期愈合、组织坏死等并发症上均无统计学差异(P0.05)。结论:硬膜外镇痛泵联合鸡尾酒疗法对缓解膝关节置换术后疼痛具有积极作用,可以有效降低术后早期静息痛和活动痛VAS评分;及时注意患者疼痛变化,为临床上止痛药增减提供帮助。联合治疗法不增加术后并发症,促进患者早期进行功能锻炼,关节功能的早期康复,有利于提高患者满意度。
[Abstract]:Background: with the development of economy and society, the arrival of aging population, more and more elderly people suffer from osteoarthritis. Osteoarthritis is a degenerative disease, because of age, obesity, fatigue. Trauma and other factors caused by degeneration of articular cartilage injury, articular edge and subchondral bone reactive hyperplasia. Clinical manifestations of slow development of joint pain, tenderness, stiffness, joint swelling. At present, the main disease in the middle and late stage of the disease is total knee arthroplasty (TKAA Total knee arthroplasty). It is also the most effective treatment for osteoarthritis at present, which can relieve pain, correct joint deformity and restore motor function, so it is favored by elderly patients. Because the patients with osteoarthritis are generally older, and there are many pain factors after TKA, postoperative pain affects patients' satisfaction and rehabilitation of joint function. Postoperative pain management has become an unavoidable problem. At present, there are many clinical analgesic schemes, but there is no ideal treatment, this paper through a retrospective study. To study the analgesic effect of epidural analgesia pump combined with cocktail therapy after the first artificial knee arthroplasty. Objective to study the analgesic effect of TKA in perioperative period, including nerve block and oral drug. The pain after knee arthroplasty was controlled by intraoperative injection of mixed analgesic drugs (cocktail therapy) and placement of epidural analgesia pump combined with analgesia after knee arthroplasty. Methods: 60 cases of osteoarthritis treated by knee arthroplasty were selected. According to the principle of random distribution, the patients in each group were divided into 3 groups. 20 patients in group A were injected with mixed analgesic drugs around the knee joint during the operation and the epidural analgesia pump was placed after operation. Patients in group B were only injected with mixed analgesic drugs in periarticular soft tissue during the operation. Group C only placed epidural analgesia pump after operation. The visual analogue score of postoperative pain and wound infection were observed in three groups. Results: there were significant differences in VAS score and VAS score of resting pain and active pain between the three groups (P < 0.05). The scores of group A (combined group) were lower than those of group B and group C (P 0.05). The scores of group A were also lower than those of group B and group C (P 0.05), regardless of the analgesia mode. The rest pain reached the peak at 24 hours after operation and the activity pain reached the peak at 36 hours after operation. The infection of incision and delayed healing were observed in the three groups. There was no significant difference in complications such as tissue necrosis. Conclusion: epidural analgesia pump combined with cocktail therapy has a positive effect on relieving pain after knee arthroplasty. It can effectively reduce the VAS score of resting pain and active pain in the early postoperative period. Pay attention to the change of pain in time and provide help for the increase and decrease of analgesic drugs in clinic. Combined therapy does not increase postoperative complications and promote early functional exercise and early rehabilitation of joint function. It is beneficial to improve patients' satisfaction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【相似文献】