超前镇痛在初次膝关节置换中的疗效分析

发布时间：2019-06-26 17:22

【摘要】：目的对比研究超前镇痛及不同给药时间在膝关节置换镇痛方面的临床疗效。方法随机选取2015年1月至2015年12月在我院行单侧TKA的患者90例。随机分成3组:A组术前3d口服塞来昔布,1次/12 h,200 mg/次,术中鸡尾酒局部关节腔注射,术后应用静脉自控镇痛泵3d、术后6h口服塞来昔布200 mg,此后1次/12 h,200 mg/次,连续7 d。B组术前6h口服塞来昔布200 mg,术中鸡尾酒局部关节腔注射,术后应用静脉自控镇痛泵3d、术后6h口服塞来昔布200 mg,此后1次/12 h,200 mg/次,连续7 d。C组术中鸡尾酒局部关节腔注射,术后应用静脉自控镇痛泵3d、术后6h口服塞来昔布200 mg,此后1次/12 h,200 mg/次,连续7 d。记录患者术后6h、12h、1d、2d、3d静息状态下疼痛视觉模拟评分(visual analogue score,VAS),记录术后1d、2d、3d、5d、7d患者活动状态下VAS评分,并登记术后1d、2d、3d、5d、7d膝关节活动度,追加盐酸哌替啶次数及镇痛相关不良反应发生情况。用SPSS 17.0行统计学分析,计量资料用t检验,计数资料用X2检验,P0.05为有统计学差异。结果(1)患者术后6h、12h、1d、2d、3d静息状态下膝关节VAS评分B组和C组大于A组,P0.05,具有统计学意义;B组大于A组,P0.05,具有统计学意义,(2)术后1d、2d、3d、5d、7d患者活动状态下膝关节VAS评分B组和C组大于A组,P0.05,具有统计学意义;B组大于A组,P0.05,具有统计学意义,(3)术后1d、2d、3d、5d、7d膝关节活动度:B组和C组低于A组,P0.05,具有统计学意义;B组低于A组,P0.05,具有统计学意义,(4).各组镇痛相关不良反应发生情况:三组之间无明显差异,P0.05,无统计学意义;A组追加盐酸哌替啶的次数明显低于B组及C组,P0.05,具有统计学意义。结论通过对比研究超前镇痛及不同给药时间在膝关节置换镇痛方面的临床疗效。发现术前口服塞来昔布超前镇痛联合多模式镇痛组具有良好的镇痛效果,对早期膝关节功能恢复有明显优势,没有增加并发症,并且发现超前镇痛术前不同给药时间其镇痛效果不同。
[Abstract]:Objective to compare the clinical efficacy of preemptive analgesia and different administration time in knee arthroplasty analgesia. Methods from January 2015 to December 2015, 90 patients with unilateral TKA were randomly selected. Group A was randomly divided into three groups: group A was given celecoxib 3 days before operation, once a 12 hours, 200 mg/ times, intraoperative cocktail local joint cavity injection, postoperative intravenous automatic analgesia pump 3 days, celecoxib 200 mg, once a 12 hours after operation, 200 mg/ times, 7 D.B group 6 hours before operation, celecoxib 200 mg, intraoperative cocktail local joint cavity injection, postoperative use of intravenous self-controlled analgesia pump 3 days after operation, the patients in group A were treated with celecoxib 200 mg, intraoperative joint cavity injection for 6 hours before operation, and the patients in group A were treated with celecoxib 200 mg, intraoperative joint cavity injection for 3 days after operation. At 6 h after operation, celecoxib 200 mg, was taken once / 12 h, 200 mg/ times, 7 d. C group intraoperative cocktail local joint cavity injection, 3 d postoperative intravenous automatic analgesia pump, 6 h after operation, celecoxib 200 mg, was taken once a 12 h, 200 mg/ times for 7 d. The visual analog score of pain was recorded at 6 h, 12 h, 2 d, 3 d, 5 d, 7 d after operation, and the VAS score was recorded on the 1st day, 2nd day, 5th day, 7th day and 7th day after operation. SPSS 17.0 was used for statistical analysis, t test for measurement data, X2 test for counting data, and P 0.05 for statistical difference. Results (1) the VAS score of knee joint in group B and C was significantly higher than that in group A, P0.05, group B was larger than group A, P0.05, and group B was larger than group A, P0.05, respectively. (2) on the 1st day, 3rd day, 5th day, the VAS score of knee joint in group B and group C was higher than that in group A, P0.05, with statistical significance. Group B was larger than group A, P0.05, with statistical significance. (3) on the 1st day, 2nd day, 5th day and 7th day after operation, the range of knee motion in group B and C was lower than that in group A, P0.05, and that in group B was lower than that in group A, P0.05, with statistical significance, (4). The incidence of adverse reactions related to analgesia in each group: there was no significant difference among the three groups, P0.05, but the frequency of pethidine hydrochloric acid in group A was significantly lower than that in group B and C, P0.05, with statistical significance. Conclusion the clinical efficacy of preemptive analgesia and different administration time in knee arthroplasty analgesia was studied by comparing the clinical efficacy of preemptive analgesia and different administration time. It was found that oral celecoxib preemptive analgesia combined with multimode analgesia group had good analgesic effect, had obvious advantages in early knee joint function recovery, and did not increase complications. It was found that the analgesic effect was different at different time before preoperation.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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