两种镇痛方法对全膝关节置换围置换期应激反应及血管活性物质的影响

发布时间：2018-03-30 03:35

  本文选题：关节成形术　切入点：置换　出处：《中国组织工程研究》2017年31期

【摘要】：背景:对全膝关节置换患者疼痛的处理一直是临床治疗中关注的重点,寻找安全有效的镇痛方法是外科医生临床研究及工作的重要任务。目的:对比股神经阻滞自控镇痛与自控硬膜外镇痛对全膝关节置换患者围术期应激反应及血流动力学的影响。方法:选择2012年8月到2016年1月在海南医学院第一附属医院进行单侧全膝关节置换的患者60例,根据入院顺序分为观察组与对照组,每组30例。全膝关节置换手术由同一组高年资医生完成,均采用标准的全膝关节置换,对照组采用自控硬膜外镇痛,观察组采用股神经阻滞自控镇痛。观察2组预后、围置换期应激反应及血管活性物质变化情况。结果与结论:(1)观察组术后4,24,48 h的应激目测类比评分均显著低于对照组(P0.05);(2)观察组术后24,48 h血清5-羟色胺质量浓度均显著低于对照组(P0.05);(3)2组术前患肢美国膝关节协会评分差异无显著性意义,术后均呈现明显增加的趋势(P0.05),同时观察组术后1,3个月的美国膝关节协会评分显著高于对照组(P0.05);(4)观察组术后3个月的呼吸抑制、尿潴留、肺不张、皮肤瘙痒、恶心呕吐等并发症发生情况明显少于对照组(P0.05);(5)结果提示,相对于自控硬膜外镇痛,股神经阻滞自控镇痛应用于全膝关节置换围手术期能缓解应激疼痛反应,降低5-羟色胺的表达,减少并发症的发生,从而促进患者关节功能的恢复。
[Abstract]:Background: the treatment of pain in patients with total knee arthroplasty has been the focus of clinical treatment. It is an important task for surgeons to find safe and effective analgesic methods. Objective: to compare the perioperative stress response and blood flow of patient-controlled analgesia by femoral nerve block and patient-controlled epidural analgesia in patients undergoing total knee arthroplasty. Methods: from August 2012 to January 2016, 60 patients underwent unilateral total knee arthroplasty in the first affiliated Hospital of Hainan Medical College. According to the order of admission, the patients were divided into observation group and control group with 30 cases in each group. Total knee arthroplasty was performed by an elderly doctor in the same group, and standard total knee arthroplasty was performed in the control group. The control group was treated with self-controlled epidural analgesia. The patient controlled analgesia with femoral nerve block was used in the observation group, and the prognosis of the two groups was observed. Results and conclusion the stress visual analogue scores of the observation group at 24 hours after operation were significantly lower than those of the control group (P < 0.05); the serum 5-hydroxytryptamine concentration in the observation group was significantly lower than that in the control group at 2448 hours after operation. There was no significant difference in the score of the American knee Association (AJA) between the two groups before operation, which was lower than that in the control group (P 0.05). At the same time, the scores of the American knee Association at 1 and 3 months after operation in the observation group were significantly higher than those in the control group (P 0.05 / 4)) the respiratory inhibition, urinary retention, atelectasis, pruritus and pruritus in the observation group were significantly higher than those in the control group 3 months after operation. The incidence of nausea and vomiting was significantly lower than that of the control group (P 0.05). The results indicated that compared with the patient controlled epidural analgesia, patient-controlled analgesia with femoral nerve block could relieve the stress pain response in the perioperative period of total knee arthroplasty. Reduce the expression of 5-hydroxytryptamine, reduce the incidence of complications, thus promoting the recovery of joint function in patients.
【作者单位】： 海南医学院第一附属医院麻醉科;
【基金】：海南省自然科学基金项目(813189):炎症因子调节围手术期老年病人血糖代谢对术后认知功能的影响~~
【分类号】：R614
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本文编号：1684174