本文選題：全膝關(guān)節(jié)置換 + 雞尾酒療法　； 參考：《中國矯形外科雜志》2017年18期

【摘要】：[目的]探討人工全膝關(guān)節(jié)置換術(shù)后,雞尾酒局部鎮(zhèn)痛對患者皮溫及術(shù)后疼痛評分的影響以及膝關(guān)節(jié)皮溫變化曲線的意義。[方法]2015年10月~2016年6月收集78例擬行初次單側(cè)人工全膝關(guān)節(jié)置換術(shù)的膝骨性關(guān)節(jié)炎患者,隨機分為雞尾酒組與常規(guī)組,每組39例。雞尾酒組患者術(shù)中膝關(guān)節(jié)周圍注射雞尾酒式鎮(zhèn)痛藥物并采用分段阻滯,即術(shù)野顯露時及關(guān)閉關(guān)節(jié)囊前分別注射雞尾酒25 ml,而常規(guī)組術(shù)中不做任何處理。所有患者術(shù)前術(shù)后處理方案均一致。比較兩組術(shù)后4、8、12h靜息時及術(shù)后24、48、72 h活動時疼痛視覺模擬評分(visual analogue scale,VAS)、雙側(cè)膝關(guān)節(jié)皮溫、膝關(guān)節(jié)最大被動活動度(range of motion,ROM)以及術(shù)后追加止痛藥的情況。[結(jié)果]雞尾酒組的VAS評分顯著低于常規(guī)組(P0.05);術(shù)后1周ROM均優(yōu)于常規(guī)組;雞尾酒組雙側(cè)平均皮溫在前3 d較常規(guī)組有所降低,且術(shù)后第5~7 d兩組患者膝關(guān)節(jié)皮溫差達到峰值。[結(jié)論]雞尾酒鎮(zhèn)痛能夠降低全膝關(guān)節(jié)置換術(shù)后膝關(guān)節(jié)局部皮溫和疼痛,顯著提高了患者術(shù)后活動度。皮溫作為一個較VAS評分更加客觀的指標可能術(shù)后炎癥控制方面有著獨到的作用。
[Abstract]:[objective] to investigate the effect of cocktail local analgesia on skin temperature and postoperative pain score after total knee arthroplasty and the significance of knee joint skin temperature curve. [methods] from October 2015 to June 2016, 78 patients with knee osteoarthritis undergoing the first unilateral total knee arthroplasty were randomly divided into cocktail group and routine group with 39 cases in each group. Cocktails were injected into the knee around the knee of the patients in the cocktail group and adopted segmental block, that is, 25 ml cocktails were injected during the exposure of the surgical field and before the closure of the articular capsule, while in the routine group, no treatment was performed during the operation. All the patients had the same treatment plan before and after operation. The visual analogue scale and skin temperature of bilateral knee joint and the maximal passive motion of knee joint were compared between the two groups at the rest time of 812 hours after operation and the visual analogue scale score at 24 minutes and 72 hours after operation, as well as the addition of pain relievers after operation. [results] the VAS score of the cocktail group was significantly lower than that of the routine group (P 0.05), the ROM of the cocktail group was better than that of the routine group 1 week after operation, the average skin temperature of both sides in the cocktail group was lower than that of the routine group on the first 3 days, and the skin temperature difference of the knee joint reached the peak value in the two groups on the 5th and 7th day after operation. [conclusion] Cocktail analgesia can reduce the local skin mild pain after total knee arthroplasty, and improve the postoperative activity of the patients. As a more objective index than VAS score, skin temperature may play a unique role in postoperative inflammation control.
【作者單位】： 山東大學附屬省立醫(yī)院關(guān)節(jié)外科;
【分類號】：R687.4

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