人工全膝关节置换术围手术期多模式镇痛的研究

发布时间：2018-07-24 10:26

【摘要】：目的:研究探讨多模式镇痛与传统镇痛方法在全膝关节置换术后镇痛效果、膝关节后HSS评分以及膝关节活动度方面的临床疗效比较。方法:连续入选2014年9月至2016年10月在我院关节外科就诊的行单侧人工全膝关节置换术的患者共98例。按照镇痛方法的不同分为两组,对照组50例,实验组48例,所有患者的手术均由组内同一位手术熟练的教授完成。结果:1、在控制相关变量的情况下,建立重复测量的混合效应模型,试验组较对照组的VAS疼痛评分要低0.48(95%CI:-0.64~-0.34),有统计学差异(P0.0001)。与术后1周相比,术后8周患者VAS评分平均下降了0.32,P=0.0001,差异有统计学意义;术后12周患者VAS评分平均下降了0.66,P0.0001,差异有统计学意义。2、在控制相关变量的情况下,建立重复测量的混合效应模型,对照组较试验组的膝关节HSS评分要低0.68,但没有统计学差异(P=0.204)。与术后1周相比,术后4周患者膝关节HSS评分平均升高了2.20,P=0.003,术后8周患者膝关节HSS评分平均升高了3.94,P0.0001,差异有统计学意义;术后12周患者膝关节HSS评分平均升高了3.82,P0.0001,差异有统计学意义。3、在控制相关变量的情况下,建立重复测量的混合效应模型,试验组较对照组的膝关节活动度要高4.47(95%CI:2.47~6.47),有统计学差异(P.0001)。与术后1周相比,术后4周患者关节活动度平均升高了3.57,P=0.0113,术后8周患者关节活动度平均升高了8.57,P0.0001,差异有统计学意义;术后12周患者关节活动度平均升高了4,P0.0046,差异有统计学意义。结论:1、TKA是治疗终末期膝关节骨性关节炎的有效方式。2、在控制年龄、性别、体重指数及术前VAS评分的情况下,多模式镇痛组的镇痛效果优于传统镇痛组,且多模式镇痛组并未增加镇痛药物过量带来的副作用,如头痛、恶心呕吐等。3、在改善术后膝关节活动度、提高膝关节HSS评分方面多模式镇痛组优于传统镇痛组。
[Abstract]:Objective: to investigate the clinical efficacy of multi-mode analgesia and traditional analgesia in postoperative analgesia after total knee arthroplasty (TKA), HSS score of knee joint and knee motion. Methods: from September 2014 to October 2016, 98 patients underwent unilateral total knee arthroplasty in our hospital. According to the different methods of analgesia, the patients were divided into two groups: the control group (50 cases) and the experimental group (48 cases). All the patients were operated by the same skilled professor in the group. Results under the condition of controlling the relative variables, the mixed effect model of repeated measurement was established. The VAS pain score of the trial group was 0.48 (95%CI:-0.64~-0.34) lower than that of the control group (P0.0001). Compared with 1 week after operation, the average VAS score of the patients decreased by 0.32 ~ 0.0001 at 8 weeks after operation, the difference was statistically significant, while at 12 weeks after operation, the average VAS score of the patients decreased by 0.66g / P0.0001, the difference was statistically significant. The HSS score of knee joint in the control group was 0.68 lower than that in the experimental group, but there was no statistical difference (P0. 204). Compared with 1 week after operation, the average HSS score of knee joint increased 2.20 P0. 003 at 4 weeks after operation, and the HSS score of knee joint increased by 3. 94% P0. 0001 at 8 weeks after operation. The difference was statistically significant. At 12 weeks after operation, the average HSS score of knee joint increased by 3.82 P0.0001, the difference was statistically significant. Under the condition of controlling the related variables, the mixed effect model of repeated measurement was established. The range of knee joint motion in the trial group was 4.47 (95%CI:2.47~6.47) higher than that in the control group (P.0001). Compared with 1 week after operation, the average range of joint motion increased by 3.57% P0. 0113 at 4 weeks after operation, and 8 weeks after operation by 8. 57% P0. 0001, the difference was statistically significant, and at 12 weeks after operation, the average range of motion of joint increased by 4% P0. 0046 (P 0. 0046), the difference was statistically significant. Conclusion TKA is an effective method for the treatment of end-stage knee osteoarthritis. Under the condition of controlling age, sex, body mass index and preoperative VAS score, the analgesic effect of multi-mode analgesia group is better than that of traditional analgesia group. The multi-mode analgesia group did not increase the side effects caused by excessive analgesic drugs, such as headache, nausea and vomiting, etc. The multi-mode analgesia group was superior to the traditional analgesia group in improving the knee joint motion and improving the knee joint HSS score.
【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

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