全膝关节置换术多模式镇痛临床效果的随机对照试验

发布时间：2018-12-21 07:19

【摘要】：背景：人工全膝关节置换术已成为治疗膝关节终末期疾病的主要治疗方法。但该术式围手术期疼痛率仍高达90%。研究表明多模式镇痛及传统的患者自控镇痛均可有效降低人工全膝关节置换围手术期疼痛程度,但对比多模式镇痛及患者自控镇痛的研究少有报道。目的：对比研究人工全膝关节置换术围手术期多模式镇痛与传统的患者自控镇痛的有效性和安全性。方法：选择2013年2月至2014年3月在我科行初次单侧人工全膝关节置换术的患者60例。随机分为两组,实验组为多模式镇痛组(27例),术中关节腔及周围组织“鸡尾酒”镇痛药注射,术后给予阿片类药物及非甾体类消炎镇痛药物；对照组为单一的患者自控镇痛组(33例),术中未用镇痛药物,术后给于患者静脉自控镇痛。术后72小时内每隔4小时记录NRS评分,之后每天评估一次,取其平均值,对比术后第1周,第2周,第3周的NRS评分；访问并记录对比术后第1周,第2周,第3周的患者满意度；记录并对比术后24小时、48小时及72小时关节功能康复锻炼达标；记录并对比实验结束时患者镇痛药物使用总量、副作用的发生率。组间计量资料比较采用独立样本t检验,计数资料采用卡方检验,等级资料采用秩和检验。将P0.05视为有显著统计学意义。结果：(1)多模式镇痛组术后各个时间点NRS疼痛评显著低于传统的患者自控镇痛组,差异有显著性(p0.05)；(2)多模式镇痛组术后第1周,第2周,第3周患者满意度均高于传统的患者自控镇痛组,差异有显著性(p0.05)；(3)术后3周,多模式镇痛组镇痛药物使用量及副作用发生率均显著少于传统的患者自控镇痛组(p0.01)；(4)多模式镇痛组术后24小时关节功能康复锻炼达标率显著高于传统的患者自控镇痛组(p0.01)。结论：初次单侧人工全膝关节置换术围手术期采用多模式镇痛较传统的患者自控镇痛在减少镇痛药使用量的同时,可显著降低患者的疼痛程度及镇痛药副作用的发生率,并可显著加快患者术后的膝关节功能康复。
[Abstract]:Background: total knee arthroplasty has become the main treatment for end-stage knee disease. However, the perioperative pain rate is still as high as 90. The study shows that both multi-mode analgesia and traditional patient-controlled analgesia can effectively reduce the degree of perioperative pain after total knee arthroplasty, but there are few reports on the comparison of multi-mode analgesia and patient-controlled analgesia. Objective: to compare the efficacy and safety of perioperative multi-mode analgesia and traditional patient-controlled analgesia in total knee arthroplasty. Methods: from February 2013 to March 2014, 60 patients underwent the first unilateral total knee arthroplasty in our department. Two groups were randomly divided into two groups: the experimental group (n = 27) was treated with multi-mode analgesia group (n = 27), the joint cavity and surrounding tissues were injected with "cocktail" analgesics during the operation, and the opioid drugs and non-steroidal anti-inflammatory analgesic drugs were given after operation. The control group was single patient controlled analgesia group (33 cases). NRS scores were recorded every 4 hours within 72 hours after operation, and then evaluated every day. The NRS scores were compared at the 1st, 2nd and 3rd week after operation. The patients' satisfaction at the first week, the second week and the third week after operation were recorded and recorded, and 24, 48 and 72 hours after operation were recorded and compared. The total amount of analgesic drugs and the incidence of side effects were recorded and compared at the end of the experiment. Independent sample t test, chi-square test and rank sum test were used to compare the metrological data among groups. The P0.05 was regarded as statistically significant. Results: (1) the NRS pain assessment in the multi-mode analgesia group was significantly lower than that in the traditional patient-controlled analgesia group (p0.05). (2) the patients' satisfaction in the first week, the second week and the third week after operation in the multi-mode analgesia group was higher than that in the traditional patient-controlled analgesia group (p0.05). (3) at 3 weeks after operation, the dosage of analgesic drugs and the incidence of side effects in the multi-mode analgesia group were significantly lower than those in the traditional patient-controlled analgesia group (p0.01). (4) 24 hours after operation, the rate of joint functional rehabilitation in multi-mode analgesia group was significantly higher than that in traditional patient-controlled analgesia group (p0.01). Conclusion: compared with traditional patient-controlled analgesia, the first unilateral total knee arthroplasty can significantly reduce the degree of pain and the incidence of side effects of analgesics compared with the traditional patient-controlled analgesia. It can accelerate the rehabilitation of knee joint function after operation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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