连续股神经阻滞对全膝置换术（TKA）后镇痛及早期功能康复的研究

发布时间：2018-02-22 15:41

本文关键词： 多模式镇痛超前镇痛连续股神经阻滞全膝关节置换术　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：通过前瞻性随机对照临床研究,研究以连续股神经阻滞为中心的多模式镇痛对初次全膝关节置换术后镇痛及早期膝关节功能康复的影响。方法：本研究所有病例来自2015年7月-2016年3月广东省中医院大学城骨科住院部,同时按照本研究的病例纳入标准及排除标准,录入44例初次全膝关节置换病例,随机分组分为A组22例(实验组)：连续股神经阻滞联合常规镇痛方案。B组22例(对照组)：常规镇痛方案。常规镇痛方案：患者术前48小时给予塞来昔布口服(用法：每日两次,每次200毫克),缝皮前于膝关节腔行关节周围局部阻滞,术后72小时内予特耐静脉推注(每12小时一次,每次40毫克),之后改为塞来昔布口服(用法：每日两次,每次200毫克)。术后当天予灯盏花素注射剂静滴(用法：50mg加入0.9%氯化钠250m1,每天1次,持续7天),术后第2天消肿止痛膏外敷(用法：外敷术侧胭窝,每次6小时,持续7天)。根据镇痛效果、膝关节活动度、膝关节评分、总体满意度、补救性镇痛药物、不良反应来进行评估,然后完成既定观察指标的资料收集。所有数据经SPSS18.0进行分析,通过检验两组观察指标的差异性,最后得出结论并进行相关分析。结果：比较两组镇痛方案,镇痛效果方面：两组镇痛方案处理后疼痛评分随着时间变化均有下降,以连续股神经阻滞为中心的镇痛方案组的术后疼痛评分在大部分时间点比常规镇痛方案组低；膝关节活动度方面：两组镇痛方案处理后膝关节活动度随着时间变化均有增高,以连续股神经阻滞为中心的镇痛方案组的术后膝关节活动度在各个时间点比常规镇痛方案组高；膝关节评分方面：实验组术后1周的HSS评分高于对照组,差异具有统计学意义(P＜0.05)；两组患者的出院总体满意度、补救性镇痛药物使用率、不良反应发生率均无明显相关性,无统计学意义(P＞0.05)结论：实验组早期静息时及活动后的疼痛程度低于对照组,实验组早期膝关节主动及被动活动度均高于对照组,实验组术后1周的HSS评分高于对照组,提示以连续股神经阻滞为中心的多模式镇痛方案相比常规镇痛方案具有优势,能较好地满足患者全膝关节置换术后镇痛及早期膝关节功能康复的要求。
[Abstract]:Objective: to adopt prospective randomized controlled clinical study, To study the effect of multimode analgesia with continuous femoral nerve block on analgesia and early rehabilitation of knee joint after primary total knee arthroplasty. Methods: from July 2015 to March 2016 in Guangdong Province, we studied the effects of continuous femoral nerve block on analgesia and early rehabilitation of knee joint. Department of Orthopaedics, University City, At the same time, 44 cases of initial total knee replacement were recorded according to the inclusion criteria and exclusion criteria of this study. Group A (n = 22) were randomly divided into two groups: group A (n = 22): continuous femoral nerve block combined with conventional analgesia, group B (n = 22) (control group: conventional analgesia regimen). Routine analgesia regimen: patients were given celecoxib orally 48 hours before operation (administration: twice a day). 200 mg / time, periarticular local block before suture skin was performed in knee joint cavity, intravenous injection (40 mg / time, every 12 hours) was given within 72 hours after operation, and then celecoxib was given orally (twice a day, twice a day). On the day after operation, breviscapine injection was given intravenously with 0.9% sodium chloride 250ml, once a day, lasting 7 days. The second day after operation, detumescent analgesic ointment was applied externally (usage: external application of popliteal fossa, 6 hours each time). They were evaluated according to analgesic effects, knee motion, knee joint score, overall satisfaction, remedial analgesic drugs, adverse reactions, and then collected from established observation indicators. All data were analyzed by SPSS18.0. By examining the difference of observation indexes between the two groups, the conclusion was drawn and the correlation analysis was carried out. Results: comparing the analgesic schemes between the two groups, the analgesic effect of the two groups: the pain scores of the two groups decreased with time after the treatment of the two groups of analgesic schemes. The postoperative pain score of the analgesic group with continuous femoral nerve block as the center was lower than that of the routine analgesia group at most time points. The postoperative knee motion of the analgesic group with continuous femoral nerve block was higher than that of the routine analgesia group at each time point, and the knee joint score of the experimental group was higher than that of the control group at 1 week after operation. The difference was statistically significant (P < 0.05), and there was no significant correlation between the two groups in terms of overall satisfaction, the utilization rate of remedial analgesic drugs and the incidence of adverse reactions. No statistical significance P > 0.05) conclusion: the degree of pain in the experimental group at early rest and after exercise is lower than that in the control group, the active and passive motion of knee joint in the experimental group is higher than that in the control group, and the HSS score in the experimental group is higher than that in the control group at 1 week after operation. It is suggested that the multi-mode analgesic regimen with continuous femoral nerve block as the center is superior to the conventional analgesic regimen and can meet the requirements of postoperative analgesia and early functional rehabilitation of knee joint after total knee arthroplasty.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.4

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