超前和多模式联合镇痛对全膝关节置换术后的疼痛疗效观察

发布时间：2018-09-05 18:18

【摘要】：目的:通过比较对比不同镇痛方案的术后不同时间段的VAS评分,探讨超前和多模式联合镇痛对人工膝关节表面置换术(TKA)后的镇痛疗效及术后膝关节功能恢复疗效。方法:收集山西医科大学第二医院2014年1月至8月因骨关节炎行单侧人工膝关节置换手术的患者共120例,按照不同镇痛方案将患者分为四组,A组为对照组(术前和术中均无相应镇痛措施+术后应用静脉自控镇痛泵(PCIA)),研究组B组为超前镇痛组(术前口服塞来昔布+术后应用静脉自控镇痛泵(PCIA)),C组为鸡尾酒镇痛组(术中行鸡尾酒关节周围注射+术后应用静脉自控镇痛泵(PCIA)),D组为多模式联合镇痛组(术前口服塞来昔布+术中行鸡尾酒关节周围注射+术后应用静脉自控镇痛泵(PCIA))。记录四组患者在术后6h、12h、24h、48h、72h静息及负荷下VAS评分;TKA术拔管后、72h、1周、2周、3周的关节活动度;围手术期并发症发生情况。结果:(1)四组患者TKA术后膝关节活动度(ROM)进行t检验,B组、C组和D组的关节活动度在拔管时均优于A组,p均0.05,具有统计学意义。B组和C组术后拔管后、3天、1周、2周和3周比较无明显差异,P均0.05,无统计学意义;D组关节活动度在术后拔管后、72h、1周、2周、3周均优于B、C组,P均O.05,有统计学意义。(2)在术后静息状态下四组患者VAS评分采用t检验,四组患者的VAS疼痛评分随着时间延长而逐渐变小。对四组患者进行比较后,B组、C组、D组术后各阶段VAS评分均小于A组,p均0.05,具有统计意义;B组和C组比较,两组评分无明显差异,p0.05,无统计学意义;D组术后各时间段VAS评分均小于其余三组,评分P均0.05,有统计学意义。(3)在术后活动状态下给四组患者再次予以VAS评分并对结果进行t检验,其中B组、C组、D组VAS评分均小于A组,p0.05,具有统计意义;B组和C组比较,两组间无明显差距,p0.05,无统计学意义;D组患者术后各时间点评分均小于B组、C组,p0.05,差异具有统计学意义。(4)通过卡方检验对术后四组患者中术后2周内出现围手术期并发症发生率进行比较,p0.05,差异无统计学意义;四组患者在术后均未形成双下肢深静脉血栓、未出现切口坏死感染情况;(5)对四组患者进行术后KSS评分显示,B组、C组、D组均优于A组,p0.05,具有统计学意义;B组与C组间KSS评分无明显差异,p0.05,无统计学意义;D组KSS评分高于B组和C组,p0.05,差异有统计学意义。结论:本次研究显示术前超前镇痛、术中局部注射镇痛、术后静脉自控泵联合镇痛效果满意,不良反应并未增加,且操作简单安全。
[Abstract]:Objective: to compare the VAS scores of different analgesic schemes in different postoperative periods, and to explore the analgesic effect of preemptive and multi-mode combined analgesia after (TKA) and the recovery of knee joint function after operation. Methods: a total of 120 patients with osteoarthritis underwent unilateral knee arthroplasty from January to August 2014 in the second Hospital of Shanxi Medical University. According to different analgesic schemes, the patients were divided into four groups: group A as control group (PCIA), group B: preemptive analgesia group) without corresponding analgesic measures before and after operation, group B: preemptive analgesia group (oral celecoxib before operation) (PCIA) group C was used as cocktail analgesia group (PCIA) group D was given intraoperative periarticular injection of intravenous analgesia pump) for multimode combined analgesia group (oral administration of celecoxib before operation was performed on chicken tail before operation). Application of intravenous Patient-controlled Analgesia pump (PCIA). After Intraarticular injection The articular activity of the four groups was recorded at 6 h, 12 h, 24 h, 48 h and 72 h after operation, and the VAS score was assessed at 72 h, 2 weeks and 3 weeks after extubation, and the complications occurred during the perioperative period. Results: (1) the range of motion of knee joint in group B and group D were better than that in group A (0.05) in group C and group D by t test with (ROM) after TKA, which was statistically significant 3 days after extubation and 2 weeks after extubation in group B and C. There was no significant difference (P = 0.05) between group D and group C (P < 0.05). The range of joint motion in group D was significantly better than that in group B (P 0.05) at 72 h, 2 weeks and 3 weeks after extubation. (2) the VAS score of group D was evaluated by t test. The VAS pain score of the four groups gradually decreased over time. The VAS scores in group C and group D were lower than those in group A (P 0.05). There was no significant difference in scores between the two groups (p0.05). The VAS scores in group D were lower than those in the other three groups (P 0.05, P < 0.05). (3) four groups of patients were given VAS scores again and the results were tested by t test. The VAS scores in group B and C were lower than those in group A (P 0.05). There was no significant difference between the two groups (p0.05), and the scores of each time point in group D were lower than those in group B (P 0.05). (4) the perioperative period was observed in the four groups by chi-square test. There was no significant difference in the incidence of complications (P 0.05). No deep vein thrombosis of both lower extremities was formed in all the four groups. (5) the postoperative KSS score of the four groups showed that the KSS score of group B was better than that of group A (p0.05). There was no significant difference in KSS score between group B and group C (p0.05), and there was no significant difference between group D and group D (P 0.05). The score was higher than that of group B and group C (P 0.05), and the difference was statistically significant. Conclusion: preemptive analgesia, intraoperative local injection analgesia and postoperative analgesic effect with intravenous pump were satisfactory, the adverse reactions were not increased, and the operation was simple and safe.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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