电针内麻点在全膝关节置换术后镇痛的临床观察

发布时间：2018-04-08 15:15

本文选题：电针　切入点：内麻点　出处：《北京中医药大学》2015年硕士论文

【摘要】：目的：通过观察电针内麻点对人工全膝关节置换术后疼痛评分(Visual analogue score)及关节活动度的影响,探讨内麻点对缓解TKA术后疼痛的疗效及功能恢复的影响。方法：观察2013年9月-2014年10月在中国中医科学院望京医院骨关节科住院治疗并入组的60例因重度膝骨关节炎择期行单侧人工全膝关节置换的患者。将这些患者随机分成电针组和空白对照组进行临床对照研究,试验组30人,对照组30人。分别对两组患者的性别、年龄、病程、膝关节活动度、术前及术后活动时和静息时VAS评分进行统计。两组患者的手术均由一组医生完成,术中采取膝关节正中切口,在髌骨内测分离股四头肌肌腱,并将髌骨翻向外侧。两组患者均采用由德国LINK厂商生产的同一型号膝关节假体。两组患者使用同样的治疗基本措施,包括：术前宣教、术中鸡尾酒关节周围注射、术后静脉自控镇痛泵、静脉口服止痛药物；康复锻炼,从术后第一日开始使用双下肢踝泵促进血液循环,双下肢等张肌肉锻炼和抬腿,锻炼股四头肌肌力,术后第二天开始被动屈伸关节练习。两组患者术后均采用同样配方的镇痛泵；均在术后返回病房时开始使用持续物理降温,试验组术后第一日给予健侧内麻点电针治疗,以患者能耐受的强度为宜。首先采用两组独立样本非参数检验分析两组患者性别、年龄、病程、术前VAS等基线指标,证明两组患者基本数据无明显差异。采用重复测量设计观察并记录两组患者的术后第一日、第二日、第三日、第七日进行康复锻炼时和静息时的VAS评分及第七天膝关节被动活动度以及不良反应事件的发生概率所有数据用SPSS19.0软件进行统计：计量指标采用均数±标准差、计数指标采用例数及百分比进行统计描述；计量资料用t检验和非参数检验,计数资料用卡方检验。结果：试验组和对照组患者术后VAS评分：术后1d活动5.73±3.32vs6.13±3.04；静息3.17±1.44vs4.03±1.56；术后2d活动6.00±3.17vs6.10±3.05；静息3.13±1.50vs3.90±1.45术后3d活动4.60±1.67vs4.73±1.77；静息2.06±1.34vs3.16±1.44,术后7d活动3.53±1.66vs 3.87±1.94静息1.93±1.38 vs 2.03±1.34；术后前三天试验组静息VAS疼痛评分低于对照组且差异具有统计学意义(P0.05),第7天没有统计学差异,术后两组患者活动VAS疼痛评分无统计学差异(P0.05)。术后关节活动度也在发生变化,两组患者术后第七日91.97±13.8 VS 86.53±11.7。P值大于0.05,说明两组患者术后关节活动度没有统计学差异。结论：电针内麻点试验组对于膝关节术后活动痛没有明显影响,但对于静息痛的效果优于空白对照组能够有效减轻全膝关节置换早期术后静息疼痛,对于缓解患者早期术后疼痛起到一定积极的作用。
[Abstract]:Objective: to observe the effect of electroacupuncture (EA) on pain score and joint motion after total knee arthroplasty (TKA), and to explore the effect of EA on pain relief and functional recovery after TKA.Methods: from September 2013 to October 2014, 60 patients with severe knee osteoarthritis underwent unilateral total knee arthroplasty in Wangjing Hospital, Wangjing Hospital, Chinese Academy of traditional Chinese Medicine.These patients were randomly divided into electroacupuncture group and blank control group.Gender, age, course of disease, knee motion, VAS score before and after operation and resting time were statistically analyzed in both groups.The operation was performed by a doctor in both groups. The median incision of knee joint was taken during the operation. The quadriceps femoris tendon was separated from the internal patella and the patella was turned laterally.Both groups were treated with the same type of knee joint prosthesis made by German LINK manufacturer.The two groups were treated with the same basic treatment measures, including preoperation education, periarticular injection of cocktails during the operation, postoperative patient-controlled analgesia pump, oral administration of pain relievers, rehabilitation exercise,From the first day after operation, the ankle pump of both lower limbs was used to promote blood circulation, and the isomorphic muscles of both lower extremities were used to exercise and lift the legs, and the quadriceps femoris muscle strength was exercised, and the passive flexion and extension joint exercises began on the second day after operation.The patients in both groups were treated with the same analgesic pump and began to use the continuous physical cooling when they returned to the ward after operation. The experimental group was treated with normal side internal anesthesia acupuncture on the first day after operation, and the strength of patient tolerance was the best.The baseline indexes of sex, age, course of disease and preoperative VAS were analyzed by non-parametric test of two groups of independent samples, which proved that there was no significant difference in basic data between the two groups.Repeated measurement design was used to observe and record the first, second, third day after operation in both groups.On the seventh day, the VAS score of rehabilitation exercise and rest, the passive activity of knee joint and the occurrence probability of adverse events on the 7th day were counted by SPSS19.0 software: the mean 卤standard deviation was used to measure the index.The counting index is described by the number of examples and the percentage, the measurement data by t test and non-parameter test, and the counting data by chi-square test.The score was lower than that in the control group and the difference was statistically significant (P 0.05), and there was no statistical difference on the 7th day.There was no significant difference in VAS pain score between the two groups after operation (P 0.05).Conclusion: the effect of electroacupuncture on postoperative active pain of knee joint is better than that of blank control group, but the effect of electroacupuncture on postoperative active pain of knee joint is better than that of blank control group, which can effectively alleviate the postoperative resting pain in the early stage of total knee arthroplasty.It plays a positive role in relieving early postoperative pain.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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