不同“鸡尾酒”配方在全膝关节置换中镇痛疗效对比研究

发布时间：2018-06-30 04:28

本文选题：骨性关节炎 + 全膝关节置换术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:对照研究在全膝关节置换术中使用不同药物配伍成两种“鸡尾酒”配方的术后镇痛疗效及术后膝关节早期功能恢复情况。方法:本研究选入自2014年05月开始到2015年06月期间的68例患者,男10例,女58例,全部患者均为骨性关节炎(OA)行首次全膝关节置换术(TKA),详细记录:患者年龄、性别、体重;术前依据视觉模拟疼痛评分标准对患者静息状态下、活动后进行VSA评分;术前依据美国膝关节外科学会标准对患者手术侧膝关节进行KSS评分。根据全膝关节置换术中应用“鸡尾酒”镇痛配方的不同,随机将所有入选68例患者分成两组,每组各34例,均为单侧膝。手术前3天所有患者均口服塞来昔布200mg,bid。研究组(A组)鸡尾酒配方为:罗哌卡因225mg、酮咯酸氨丁三醇30mg、吗啡5mg、肾上腺素0.3mg,加生理盐水至100ml的混合液;对照组(B组)鸡尾酒配方为:罗哌卡因225mg、肾上腺素0.3mg,加生理盐水至100ml的混合液。注射部位包括:膝关节囊、膝关节内、外侧副韧带、股四头肌腱切开部分、髌韧带、髌旁支持带、皮下组织。待完成截骨及组织平衡后将药液总量的2/5注入到关节囊后方,剩余3/5在即将关闭手术切口前注入到膝周其它组织当中。记录术中所有患者的手术持续时间,术中两组患者的膝关节腔内均放置一根负压引流管,术后24h换药拔管。两组术后均行膝关节切口周围持续冰敷24h、低分子肝素4100IU皮下注射2周抗凝及常规抗感染治疗,术后第1天开始口服塞来昔布200mg,bid,如口服药物的止痛效果不理想,视情况采用曲马多100mg肌注进行处理。记录术后48h内各时间段的曲马多使用次数;两组术后恶心、呕吐、皮肤瘙痒及呼吸抑制等药物副作用发生的情况;记录并对比两组全部患者依次在术后8h、16h、24h、32h、40h、48h静息状态下与活动后VAS评分分数的差异;术后24h内关节腔引流量的差别,评估是否能提高术后出血风险;应用KSS评分标准分别记录下所有患者术后2周时的临床和功能KSS评分。结果:1患者基本资料分析:本研究选入的68例患者,全部为单侧,男10例,女58例,入院后随机分成A组与B组,A组患者中有男性4例,女性30例,年龄53~75岁,平均(61.58±11.27)岁,体重平均(66.43±7.15)kg。B组患者男性6例,女性28例,年龄54~73岁,平均(62.6±10.40)岁,体重平均(67.24±6.37)kg。手术时间:A组(101±8.56)min;B组(101±8.56)min。对比两组中全部患者的性别比例、体重、年龄、手术持续时间等均不具有统计学意义,P0.05,保证了两组其它数据具有可对比性。2静息状态下和活动后VAS评分:术前对所有入选的患者行静息状态下、活动后VAS评分,经统计学方法分析后结果:术前研究组(A组)与对照组(B组)静息状态下VAS评分6.52±0.34,6.41±0.33;活动后的VAS评分8.52±0.39,8.41±0.42,均无显著差异,P0.05,具有可比性。术后A组8h、16h、24h、32h、40h、48h静息状态下VAS评分分别为:1.89±0.36,2.63±0.31,2.98±0.43,3.12±0.44,2.71±0.32,3.01±0.31;8h、16h、24h、32h、40h、48h活动后VAS评分分别为:5.65±0.40,5.72±0.40,5.90±0.39,6.16±0.43,5.47±0.39,5.39±0.42。B组8h、16h、24h、32h、40h、48h静息状态下VAS评分分别为:2.14±0.39,2.90±0.42,3.23±0.31,3.41±0.34,2.82±0.36,3.14±0.39;8h、16h、24h、32h、40h、48h活动后VAS评分分别为:5.92±0.34,5.99±0.38,6.14±0.36,6.42±0.32,5.61±0.32,5.52±0.35。A组在8h、16h、24h、32h静息状态下和活动后的VAS评分与B组的进行对比后,均低于B组,且差别较明显,有统计学意义(P0.05),术后40h后A、B两组静息状态下和活动后的VAS评分进行对比无明显差别,无统计学意义(P0.05)。3术前、术后2周KSS评分:术前A组患者KSS临床评分、功能评分分别为:42.61±14.32,40.16±10.78,术前B组患者KSS临床评分、功能评分分别为:45.12±10.45,36.31±15.35,结果显示P0.05,无统计学差异。术后2周A组患者KSS临床评分及功能评分分别为:85.15±3.15,55.25±5.46,术后2周B组患者KSS临床评分及功能评分分别为:79.45±9.98,42.89±11.08,结果显示P0.05,研究组均优于对照组。4术后两组患者的药物副作用出现概率:两组患者出现恶心、呕吐、皮肤瘙痒及呼吸抑制等药物副作用无显著差异,P0.05,无统计学意义。5术后24h引流量:术后24h引流量研究组与对照组分别为:154.52±29.63ml和152.46±29.26ml,两组数据分析结果均为:P0.05,无统计学意义。6术后各时间段的曲马多使用次数:术后4h、8h、16h、24h、48h盐酸曲马多使用次数进行对比无明显差别,P0.05,不具有统计学意义。结论:1手术前后对入选的全部患者手术侧膝关节功能和疼痛进行分析对比,研究组和对照组这两方面均获得显著改善,但镇痛效果研究组相对更佳。2研究组“鸡尾酒”配方镇痛效果优于对照组“鸡尾酒”配方,可以有效减轻TKA患者术后膝关节周围疼痛,有利于患者早期进行膝关节功能康复锻炼,使得患者尽早回归家庭,恢复正常生活,提高患者对全膝关节置换手术各项的满意度。
[Abstract]:Objective: To study the postoperative analgesic effect of two kinds of "cocktails" combined with two kinds of "cocktails" in total knee arthroplasty and to recover the early functional recovery of the knee joint. Methods: This study was selected from 68 patients from 05 months of 2014 to 06 months in 2015, 10 men and 58 women, all of them were osteoarthritis (OA). First total knee arthroplasty (TKA) was used to record the patient's age, sex, weight, and the preoperative VSA score on the patient's resting state according to the visual analogue pain score standard, and the KSS score of the knee joint of the patients before the operation according to the standard of the American Knee Surgery Society. All 68 patients were divided into two groups randomly, 34 cases in each group were divided into two groups. All patients in each group were single knee. All patients were treated with celecoxib 200mg at 3 days before operation. The formula of cocktail of bid. study group (group A) was ropivacaine, koropalic acid three alcohol 30mg, morphine 5mg, adrenaline 0.3mg, and mixed saline to 100ml. The formula of the cocktail of the control group (group B) was ropivacaine 225mg, adrenaline 0.3mg, and mixed solution of saline to 100ml. The injection site included the knee joint capsule, the knee joint, the lateral collateral ligament, the four head of the femoral tendon, the patellar ligament, the parampatellar support band, the subcutaneous tissue. The 2/5 injection of the total amount of the medicine after the osteotomy and tissue balance were completed. After entering the joint capsule, the remaining 3/5 was injected into the other tissues of the knee before the closure of the surgical incision. The duration of the operation of all the patients during the operation was recorded. A negative pressure drainage tube was placed in the two groups of patients during the operation, and the 24h changed the tube after the operation. The two groups underwent continuous ice compress around the knee joint and low molecular liver after the operation. 4100IU was subcutaneously injected with 2 weeks anticoagulant and conventional anti infection treatment, and celecoxib 200mg was orally administered on the first day after operation. The analgesic effect of bid, such as oral medicine was not ideal, was treated with tramadol 100mg intramuscular injection. The number of Tramadol Used in each time period of 48h after the operation was recorded, and the postoperative nausea, vomiting, pruritus and respiratory inhibition in the two groups were also recorded. Such as drug side effects, record and compare the two groups of all patients in order of postoperative 8h, 16h, 24h, 32H, 40H, 48h in the resting state and the difference in the VAS score after the resting state; the difference in the volume of intra-articular cavity flow in 24h after operation to evaluate the risk of postoperative bleeding; the 2 weeks after the operation of all patients were recorded with the KSS score standard. Results: clinical and functional KSS scores. Results: the basic data of 1 patients were analyzed: 68 patients were selected in this study, all were unilateral, 10 men and 58 women. After admission, they were randomly divided into group A and group B. In group A, there were 4 men, 30 women, age 53~75, average (61.58 + 11.27) years, average weight (66.43 + 7.15) kg.B, and female 28, average weight (66.43 + 7.15) kg.B. Age 54~73 years, average (62.6 + 10.40) years, weight average (67.24 + 6.37) kg. operation time: group A (101 + 8.56) min, B group (101 + 8.56) min. compared to all patients in the two group, the sex ratio, weight, age, and the duration of operation were not statistically significant, P0.05, to ensure that two groups of other data with comparable.2 resting state and live VAS score after the operation: before the operation, all the selected patients were resting in resting state and after the activity VAS score, and the results were statistically analyzed. The VAS score of the preoperative study group (group A) and the control group (group B) was 6.52 + 0.34,6.41 + 0.33, and the VAS score after the activity was 8.52 + 0.39,8.41 + 0.42. There was no significant difference between the group and the control group. There was a comparability of P0.05, and the 8h in the A group after the operation was 8h. The VAS scores of 16h, 24h, 32H, 40H and 48h were respectively 1.89 + 0.36,2.63 + 0.31,2.98 + 0.43,3.12 + 0.44,2.71 + 0.31. 4 + 0.39,2.90 + 0.42,3.23 + 0.31,3.41 + 0.34,2.82 + 0.36,3.14 + 0.39; 8h, 16h, 24h, 32H, 40H, 48h after activity, respectively. Statistical significance (P0.05), after 40H after operation, A, B two groups in resting state and after the activity of VAS scores were not significantly different, no statistically significant (P0.05).3 preoperative, 2 weeks KSS score: preoperative A group of KSS clinical score, the function score was 42.61 + 10.78, preoperative B group clinical score, functional score, respectively The results showed that: 45.12 + 10.45,36.31 + 15.35, the results showed no statistical difference. The clinical score and function score of KSS in group A after 2 weeks were 85.15 + 3.15,55.25 + 5.46 respectively. The KSS clinical score and function score of group B patients at 2 weeks after operation were 79.45 + 9.98,42.89 + 11.08, and the results showed P0.05. The study group were all better than the two group after.4 operation in the control group. There was a probability of drug side effects: there was no significant difference in side effects between two groups of patients, such as nausea, vomiting, skin pruritus and respiratory depression, P0.05, and no significant difference in 24h flow after.5: after the operation, the 24h flow rate study group and the control group were 154.52 + 29.63ml and 152.46 + 29.26ml respectively. The results of data analysis were: P0.05, no unification. The frequency of the use of tramadol at every time after.6: no significant difference between 4h, 8h, 16h, 24h, 48h tramadol after operation, P0.05, without statistical significance. Conclusion: 1 the two aspects of the knee joint function and pain of all the patients who were selected before and after operation were analyzed and compared, the two aspects of the study group and the control group were all compared. The analgesic effect of.2 research group is better than that of the control group "cocktail" formula, which can effectively reduce the pain around the knee joint of the TKA patients after operation, and help the patients to carry out the rehabilitation of the knee joint function early, and make the patients return to the family as soon as possible and restore the normal life. High patient satisfaction with total knee arthroplasty.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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