【摘要】：目的:通過比較對(duì)比不同鎮(zhèn)痛方案的術(shù)后不同時(shí)間段的VAS評(píng)分,探討超前和多模式聯(lián)合鎮(zhèn)痛對(duì)人工膝關(guān)節(jié)表面置換術(shù)(TKA)后的鎮(zhèn)痛療效及術(shù)后膝關(guān)節(jié)功能恢復(fù)療效。方法:收集山西醫(yī)科大學(xué)第二醫(yī)院2014年1月至8月因骨關(guān)節(jié)炎行單側(cè)人工膝關(guān)節(jié)置換手術(shù)的患者共120例,按照不同鎮(zhèn)痛方案將患者分為四組,A組為對(duì)照組(術(shù)前和術(shù)中均無相應(yīng)鎮(zhèn)痛措施+術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵(PCIA)),研究組B組為超前鎮(zhèn)痛組(術(shù)前口服塞來昔布+術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵(PCIA)),C組為雞尾酒鎮(zhèn)痛組(術(shù)中行雞尾酒關(guān)節(jié)周圍注射+術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵(PCIA)),D組為多模式聯(lián)合鎮(zhèn)痛組(術(shù)前口服塞來昔布+術(shù)中行雞尾酒關(guān)節(jié)周圍注射+術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵(PCIA))。記錄四組患者在術(shù)后6h、12h、24h、48h、72h靜息及負(fù)荷下VAS評(píng)分;TKA術(shù)拔管后、72h、1周、2周、3周的關(guān)節(jié)活動(dòng)度;圍手術(shù)期并發(fā)癥發(fā)生情況。結(jié)果:(1)四組患者TKA術(shù)后膝關(guān)節(jié)活動(dòng)度(ROM)進(jìn)行t檢驗(yàn),B組、C組和D組的關(guān)節(jié)活動(dòng)度在拔管時(shí)均優(yōu)于A組,p均0.05,具有統(tǒng)計(jì)學(xué)意義。B組和C組術(shù)后拔管后、3天、1周、2周和3周比較無明顯差異,P均0.05,無統(tǒng)計(jì)學(xué)意義;D組關(guān)節(jié)活動(dòng)度在術(shù)后拔管后、72h、1周、2周、3周均優(yōu)于B、C組,P均O.05,有統(tǒng)計(jì)學(xué)意義。(2)在術(shù)后靜息狀態(tài)下四組患者VAS評(píng)分采用t檢驗(yàn),四組患者的VAS疼痛評(píng)分隨著時(shí)間延長(zhǎng)而逐漸變小。對(duì)四組患者進(jìn)行比較后,B組、C組、D組術(shù)后各階段VAS評(píng)分均小于A組,p均0.05,具有統(tǒng)計(jì)意義;B組和C組比較,兩組評(píng)分無明顯差異,p0.05,無統(tǒng)計(jì)學(xué)意義;D組術(shù)后各時(shí)間段VAS評(píng)分均小于其余三組,評(píng)分P均0.05,有統(tǒng)計(jì)學(xué)意義。(3)在術(shù)后活動(dòng)狀態(tài)下給四組患者再次予以VAS評(píng)分并對(duì)結(jié)果進(jìn)行t檢驗(yàn),其中B組、C組、D組VAS評(píng)分均小于A組,p0.05,具有統(tǒng)計(jì)意義;B組和C組比較,兩組間無明顯差距,p0.05,無統(tǒng)計(jì)學(xué)意義;D組患者術(shù)后各時(shí)間點(diǎn)評(píng)分均小于B組、C組,p0.05,差異具有統(tǒng)計(jì)學(xué)意義。(4)通過卡方檢驗(yàn)對(duì)術(shù)后四組患者中術(shù)后2周內(nèi)出現(xiàn)圍手術(shù)期并發(fā)癥發(fā)生率進(jìn)行比較,p0.05,差異無統(tǒng)計(jì)學(xué)意義;四組患者在術(shù)后均未形成雙下肢深靜脈血栓、未出現(xiàn)切口壞死感染情況;(5)對(duì)四組患者進(jìn)行術(shù)后KSS評(píng)分顯示,B組、C組、D組均優(yōu)于A組,p0.05,具有統(tǒng)計(jì)學(xué)意義;B組與C組間KSS評(píng)分無明顯差異,p0.05,無統(tǒng)計(jì)學(xué)意義;D組KSS評(píng)分高于B組和C組,p0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:本次研究顯示術(shù)前超前鎮(zhèn)痛、術(shù)中局部注射鎮(zhèn)痛、術(shù)后靜脈自控泵聯(lián)合鎮(zhèn)痛效果滿意,不良反應(yīng)并未增加,且操作簡(jiǎn)單安全。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614

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