摘要
目的:评价多模式围手术期疼痛控制方案在全膝关节置换术后镇痛中的作用,并与非多模式镇痛方案进行对比。方法:选择2004-09/2006-09在长征医院关节外科中心实施多模式围手术期疼痛控制方案前后接受单侧全膝关节置换的患者各50例,实施该方案前接受手术的患者作为非多模式镇痛组,实施该方案后接受手术的患者作为多模式镇痛组。①实验方法:多模式镇痛组患者术前口服塞来昔布;手术结束关闭切口前在皮下周围组织中注射复合麻醉剂;术后口服塞来昔布及奥斯康定,不给患者使用自控镇痛泵或其他形式的非胃肠道注射用药,疼痛用口服止痛药难以控制时,肌肉注射哌替啶75～100mg。非多模式镇痛组主要采用患者自控镇痛和非胃肠道注射用止痛药,术前不给药,手术结束时给患者使用静脉自控镇痛泵直到术后48h,或在术后根据患者需要哌替啶100mg每6h肌肉注射。②实验评估:比较两组患者术后不同时间点膝关节疼痛评分、术后麻醉剂使用情况、膝关节功能康复情况以及术后并发症的发生情况。结果:100例患者均进入结果分析。①术后4,6h多模式镇痛组患者的静息痛、活动痛疼痛评分均显著低于非多模式镇痛组(P<0.05～0.01)。②多模式镇痛组患者从手术结束至第1次需要使用麻醉剂的时间间隔显著长于非多模式镇痛组(P<0.01)。③多模式镇痛组患者术后的主动直腿抬高时间、主动屈膝90°时间均显著短于非多模式镇痛组(P<0.01),出院时多模式镇痛组患者的平均膝关节活动度显著大于非多模式镇痛组(P<0.01)。④在患者术后伤口愈合、感染发生率、血压、心率、皮肤瘙痒、意识清醒程度、肝肾功能及平滑肌功能等方面,两组差异均无显著性意义(P>0.05)。结论:多模式围手术期疼痛控制方案可以减轻全膝关节置换患者的术后疼痛,缩短住院时间,减少术后麻醉剂使用量,有助于患者的早期康复,同时具有并发症少、操作简单、安全的优点。
AIM： To evaluate the effect of a multimodal perioperative pain control protocol in total knee arthroplasty （TKA）, and compare it with a non-multimodal pain control protocol. METHODS： Two cohorts of 50 consecutive TKA patients were selected from Department of Orthopaedics, Changzheng Hospital before and after the initiation of the protocol from September 2004 to September 2006. Patients before initiation of the protocol was as the non-multimodal pain control group, and patients after initiation of the protocol was as the multimodal pain control group. ①Before the operation, the patients of multimodal pain control group orally took celecoxib, local anesthetic wound infiltration in the operation and celecoxib and oycontin after the operation. No intrathecal narcotics or patient-controlled analgesia （PCRA） were utilized. 75-100 mg duramorph was used when pain was not well controlled with oral narcotics. The non-multimodal pain control protocol involved intrathecal narcotics and PCRA. After the operation PCRA was used until 48 hours, or duramorph 100 mg was used every 6 hours as necessary during the postoperative period. ②The following parameters were compared, including the postoperative pain scores at different times, the total consumption of anesthetic, the postoperative rehabilitations of the knee, and the complications. RESULTS： 100 patients were involved in the result analysis. ①The TKA patients of the multimodel pain control group had significantly lower rest pain scores and activity pain scores at hours 4 and 6 after operation than the non-multimodel pain control group.（P 〈 0.05-0.01 ）. ②The TKA patients of multimodel pain control group had significantly less narcotic consumption than TKA patients of the non-multimodel pain control group （P 〈 0.01 ）. ③The TKA patients of the multimodel pain control group needed significantly less time for the range of movement （ROM） to arrive 90 degrees than the patients of the non-multimodel pain control group （P 〈 0.01 ）, and the mean knee ROM of the patients in the multimodel pain control group was obviously larger than that of the non-multimodel pain control group （P 〈 0.01）. ④ There were no significant differences in complications such as wound healing, incidence rate of infection, blood pressure, heart rate, itch of skin, consciousness, function of liver and kidney, smooth muscle function and so on（P 〉 0.05）. CONCLUSION： Perioperative utilization of muitimodal analgesia protocol has shortened length of stay, improved pain, decreased narcotic consumption, provided for faster functional recovery and reduced side effects. It is characterized by simple operation and safety.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第36期7223-7226,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
