关节内注射鸡尾酒式镇痛复合液的近期及远期效果
发布时间：2018-08-12 20:30
【摘要】：目的:评估全膝关节置换术后关节内注射鸡尾酒式镇痛复合液镇痛的近期及远期效果。方法:由相同的医师组手术治疗的的单侧TKA骨性关节炎(OA)患者40例(40膝),并随机分成两组(A组和B组),分别为20人,A组中有男性患者3名,女性患者17名,年龄54-76岁,平均(62.75±5.80)岁;B组中有男性患者2名,女性患者18名,年龄51-67岁,平均(59.95±1.04)岁。A组术中采取“鸡尾酒”方案,即:罗哌卡因注射液150 mg、舒芬太尼注射液10ug,加生理盐水至100 ml,对关节周围软组织(包含关节囊、韧带和皮下组织)进行注射。整个过程分为三步。首先,截骨后于关节后方关节囊注射约40ml,注射前轻轻回抽以防止注入乆窝血管。然后,安装假体后在骨水泥固化前,于内外侧副韧带、前方关节囊、骨膜、股四头肌腱、关节囊切口及髌下韧带注射30ml,最后关闭切口及松止血带前在切口周围(皮下组织)注射30ml。B组:术中只给予生理盐水100 ml,不包括罗哌卡因及舒芬太尼,与A组患者操作一致,对关节周围软组织(包含关节囊、韧带和皮下组织)进行注射。若患者术后自觉疼痛无法忍受,可给患者100 mg盐酸曲马多肌注。比较两组患者术后48小时内的患者镇痛药物追加次数、一般情况及不良反应发生情况,术后48小时内及术后1年时膝关节视觉模拟疼痛评分。VAS评分的操作是采用一条约10cm长的尺子,一个面刻有10个刻度,两端各自表示为0分和10分,0分代表了无痛,10分代表了难以忍受的剧痛,中间部分代表了不同程度的疼痛,测试时患者面对着无刻度的一面,让其在标尺上指出能代表自己此时疼痛程度的相应的位置。同时操作者面对有刻度的一面,然后再根据患者标出的位置得到相应的分值。随访时的活动VAS评分通过爬楼梯测试来完成,具体操作如下:让随访患者爬上10阶楼梯(每阶大概15cm高),然后再回到原点。其中慢性疼痛定义为术后1年时在爬楼梯试验中VAS评分大于等于4的疼痛。结果:1两组患者在年龄、性别比例、体重及手术时间等方面均无统计学意义(P0.05)。2术后48小时内VAS评分A组患者静息时的VAS评分在4h、8h、16h、24h、48h时分别为3.27±0.39,3.46±0.41,4.08±0.31,3.47±0.42,3.33±0.36,活动时的VAS评分在4h、8h、16h、24h、48h时分别为4.14±0.46,4.80±0.44,5.17±0.44,4.62±0.36,4.32±0.30;B组患者静息时的VAS评分在4h、8h、16h、24h、48h时分别为3.38±0.40,4.05±0.29,4.65±0.40,4.48±0.32,3.29±0.37,活动时的VAS评分在4h、8h、16h、24h、48h时分别为4.85±0.38,5.35±0.30,5.74±0.34,5.41±0.36,4.40±0.31。A组患者活动时的VAS评分在术后4h、8h、16h、24h均低于B组,具有统计学差异(P0.05),术后48h后两组患者的VAS评分无显著性差异(P0.05);两组患者静息时的VAS评分在术后4h内的差异无统计学意义(P0.05),而A组患者术后8h、16h、24h的VAS评分均较B组患者低,差异具有统计学意义(P0.05),术后48h后两组患者的VAS评分无显著性差异(P0.05)。3术后镇痛药物追加次数两组患者术后盐酸曲马多在各个时间段的追加次数无统计学差异(P0.05)。4术后一般情况两组患者在心率、血氧饱和度及平均动脉压等生命体征上,差异无统计学意义(P0.05)。5不良反应发生率A组与B组比较,两组患者术后的恶心、呕吐、皮肤瘙痒以及呼吸抑制等不良反应的发生率差异无显著性(P0.05)。6术后1年随访情况两组患者静息时的VAS评分分别为0.89±0.25和1.06±0.34,无统计学差异(P0.05);活动时的VAS评分分别为2.81±0.47和3.22±0.68,A组患者VAS评分较B组患者低,具有统计学意义(P0.05)。A组患者慢性疼痛发生率为5.0%(1/20),B组为30.0%(6/20),B组患者慢性疼痛发生率明显高于A组,具有统计学差异(P0.05),尚不能排除B组慢性疼痛的发生率是A组慢性疼痛发生率的6倍。结论:关节腔内注射鸡尾酒镇痛可以有效缓解术后急性疼痛,促进早期功能恢复,并且在预防患者的慢性疼痛方面起到了重要作用,是全膝关节置换术后镇痛的良好选择。
[Abstract]:Objective: To evaluate the short-term and long-term effects of intra-articular injection of cocktail analgesic compound solution after total knee arthroplasty (TKA). Methods: 40 patients (40 knees) with unilateral TKA osteoarthritis (OA) were divided into two groups (group A and group B) randomly. There were 20 patients in group A, 3 males and 17 females. The age ranged from 54 to 76 years, with an average age of (62.75 (+ 5.80) years. In group B, there were 2 males and 18 females, aged 51 to 67 years, with an average age of (59.95 (+ 1.04) years. Tissue) Injection. The whole process is divided into three steps. First, about 40 ml is injected into the posterior articular capsule after osteotomy, then gently withdrawn before injection to prevent injection into the fovea. Then, 30 ml is injected into the medial and lateral collateral ligaments, anterior capsule, periosteum, quadriceps tendon, capsule incision and Subpatellar ligament before cementation. Inject 30 ml of saline around the incision (subcutaneous tissue) before closing the incision and loosening the tourniquet. In group B, only 100 ml of normal saline, excluding ropivacaine and sufentanil, was administered intraoperatively. The soft tissues around the joint (including the joint capsule, ligaments and subcutaneous tissue) were injected as in group A. If the patient felt that the pain could not be tolerated after the operation, the saline was administered. Patients received 100 mg tramadol hydrochloride intramuscular injection. The number of additional analgesic drugs, general conditions and adverse reactions were compared between the two groups within 48 hours after operation. Visual analogue pain score of knee joint was obtained within 48 hours after operation and 1 year after operation. VAS was performed by using a ruler about 10 cm long with 10 scales on one side and 10 scales on both ends. Self-reported 0 and 10 points, 0 points for pain, 10 points for unbearable pain, the middle part represents varying degrees of pain, the test patients face the scale, let them point out on the scale can represent the degree of pain at this time the corresponding position. The active VAS score at follow-up was achieved by stair climbing test. The following procedure was performed: follow-up patients climbed 10 stairs (about 15 cm high each) and then returned to the original point. Chronic pain was defined as pain with a VAS score greater than or equal to 4 in stair climbing test at 1 year after surgery. There was no significant difference in age, sex ratio, body weight and operation time between the two groups (P 0.05). VAS score at rest in group A was 3.27 [0.39], 3.46 [0.41], 4.08 [0.31], 3.47 [0.42], 3.33 [0.36], and VAS score at activity was 4 h, 8 h, 16 h, 24 h, 48 h, respectively. 46,4.46,4.80 [0.44,4.80 [0.44,5.17 [0.44,0.44,5.17 [0.44,4.62 [0.36,4.32 [0.36,4.32 [0.36,4.32 [0.30.38 [0.40,0.40,4.05 [0.29,4.29,4.65 [0.65 [0.40,40.40.40,4.48 [.48 [0.32,4.48 [0.32,3.29 [0.37,VAS at 4.85 [0.38,0.38,5.35.35.38,35.35.30,35.35.35.30,35.35.VAS during activity in group A The VAS scores in group A were lower than those in group B at 4, 8, 16 and 24 hours after operation (P 0.05). There was no significant difference in VAS scores between the two groups 48 hours after operation (P 0.05). There was no significant difference in resting VAS scores between the two groups within 4 hours after operation (P 0.05). The VAS scores in group A were lower than those in group B at 8, 16 and 24 hours after operation (P 0.05). Significance (P 0.05). There was no significant difference in VAS score between the two groups 48 hours after operation (P 0.05). 3 There was no significant difference in the number of postoperative tramadol hydrochloride addition between the two groups (P 0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, pruritus and respiratory depression between group A and group B (P 0.05). The VAS scores at rest were 0.89 (+ 0.25) and 1.06 (+ 0.34) at 1 year follow-up, respectively, with no significant difference between the two groups (P 0.05). The VAS score of group A was lower than that of group B (P 0.05). The incidence of chronic pain in group A was 5.0% (1/20), and that in group B was 30.0% (6/20). The incidence of chronic pain in group B was significantly higher than that in group A (P 0.05). The incidence of chronic pain in group A was significantly higher than that in group B (P 0.05). Conclusion: Intra-articular injection of cocktail analgesia can effectively relieve postoperative acute pain, promote early functional recovery, and play an important role in preventing chronic pain in patients with total knee arthroplasty, which is a good choice for postoperative analgesia.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
[Abstract]:Objective: To evaluate the short-term and long-term effects of intra-articular injection of cocktail analgesic compound solution after total knee arthroplasty (TKA). Methods: 40 patients (40 knees) with unilateral TKA osteoarthritis (OA) were divided into two groups (group A and group B) randomly. There were 20 patients in group A, 3 males and 17 females. The age ranged from 54 to 76 years, with an average age of (62.75 (+ 5.80) years. In group B, there were 2 males and 18 females, aged 51 to 67 years, with an average age of (59.95 (+ 1.04) years. Tissue) Injection. The whole process is divided into three steps. First, about 40 ml is injected into the posterior articular capsule after osteotomy, then gently withdrawn before injection to prevent injection into the fovea. Then, 30 ml is injected into the medial and lateral collateral ligaments, anterior capsule, periosteum, quadriceps tendon, capsule incision and Subpatellar ligament before cementation. Inject 30 ml of saline around the incision (subcutaneous tissue) before closing the incision and loosening the tourniquet. In group B, only 100 ml of normal saline, excluding ropivacaine and sufentanil, was administered intraoperatively. The soft tissues around the joint (including the joint capsule, ligaments and subcutaneous tissue) were injected as in group A. If the patient felt that the pain could not be tolerated after the operation, the saline was administered. Patients received 100 mg tramadol hydrochloride intramuscular injection. The number of additional analgesic drugs, general conditions and adverse reactions were compared between the two groups within 48 hours after operation. Visual analogue pain score of knee joint was obtained within 48 hours after operation and 1 year after operation. VAS was performed by using a ruler about 10 cm long with 10 scales on one side and 10 scales on both ends. Self-reported 0 and 10 points, 0 points for pain, 10 points for unbearable pain, the middle part represents varying degrees of pain, the test patients face the scale, let them point out on the scale can represent the degree of pain at this time the corresponding position. The active VAS score at follow-up was achieved by stair climbing test. The following procedure was performed: follow-up patients climbed 10 stairs (about 15 cm high each) and then returned to the original point. Chronic pain was defined as pain with a VAS score greater than or equal to 4 in stair climbing test at 1 year after surgery. There was no significant difference in age, sex ratio, body weight and operation time between the two groups (P 0.05). VAS score at rest in group A was 3.27 [0.39], 3.46 [0.41], 4.08 [0.31], 3.47 [0.42], 3.33 [0.36], and VAS score at activity was 4 h, 8 h, 16 h, 24 h, 48 h, respectively. 46,4.46,4.80 [0.44,4.80 [0.44,5.17 [0.44,0.44,5.17 [0.44,4.62 [0.36,4.32 [0.36,4.32 [0.36,4.32 [0.30.38 [0.40,0.40,4.05 [0.29,4.29,4.65 [0.65 [0.40,40.40.40,4.48 [.48 [0.32,4.48 [0.32,3.29 [0.37,VAS at 4.85 [0.38,0.38,5.35.35.38,35.35.30,35.35.35.30,35.35.VAS during activity in group A The VAS scores in group A were lower than those in group B at 4, 8, 16 and 24 hours after operation (P 0.05). There was no significant difference in VAS scores between the two groups 48 hours after operation (P 0.05). There was no significant difference in resting VAS scores between the two groups within 4 hours after operation (P 0.05). The VAS scores in group A were lower than those in group B at 8, 16 and 24 hours after operation (P 0.05). Significance (P 0.05). There was no significant difference in VAS score between the two groups 48 hours after operation (P 0.05). 3 There was no significant difference in the number of postoperative tramadol hydrochloride addition between the two groups (P 0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, pruritus and respiratory depression between group A and group B (P 0.05). The VAS scores at rest were 0.89 (+ 0.25) and 1.06 (+ 0.34) at 1 year follow-up, respectively, with no significant difference between the two groups (P 0.05). The VAS score of group A was lower than that of group B (P 0.05). The incidence of chronic pain in group A was 5.0% (1/20), and that in group B was 30.0% (6/20). The incidence of chronic pain in group B was significantly higher than that in group A (P 0.05). The incidence of chronic pain in group A was significantly higher than that in group B (P 0.05). Conclusion: Intra-articular injection of cocktail analgesia can effectively relieve postoperative acute pain, promote early functional recovery, and play an important role in preventing chronic pain in patients with total knee arthroplasty, which is a good choice for postoperative analgesia.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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