中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2014年
2期
175-180
,共6页
陈松%符培亮%吴海山%吴宇黎%钱齐荣%李晓华%祝云利%陈宜%赵辉%王波%付奇伟%丁喆如%周琦
陳鬆%符培亮%吳海山%吳宇黎%錢齊榮%李曉華%祝雲利%陳宜%趙輝%王波%付奇偉%丁喆如%週琦
진송%부배량%오해산%오우려%전제영%리효화%축운리%진의%조휘%왕파%부기위%정철여%주기
关节成形术,置换,膝%镇痛%冷冻疗法%压力
關節成形術,置換,膝%鎮痛%冷凍療法%壓力
관절성형술,치환,슬%진통%냉동요법%압력
Arthroplasty,replacement,knee%Analgesia%Cryotherapy%Pressure
目的：研究人工全膝关节置换术（ TKA）术后膝周持续冰袋加压冷敷的镇痛效果。方法2011年5月至2012年5月，将本组86例欲行单侧TKA的骨关节炎患者随机分成两组：试验组于TKA术后将毛巾包裹的10％盐水冰袋置于膝前、内、外侧冷敷，持续24 h；对照组给予同等规格的常温软包装盐水袋置于膝前、内、外侧外敷，持续48 h；两组均于术后第2天拔除引流管。术后24 h内两组患者均经静脉镇痛泵滴注吗啡行自控镇痛（PCA），疼痛难以忍受时予以肌注吗啡5～10 mg。通过比较两组患者术后膝关节静息和活动痛视觉模拟（ VAS）评分、隐性失血量、吗啡使用情况、主动直腿抬高时间、屈膝90°时间、膝关节活动度（ ROM）以及并发症来分析膝周持续冰袋冷敷的镇痛效果。结果 TKA术后膝周持续冰袋冷敷的患者，其术后36 h内各时间段以及总的吗啡消耗量明显减少（P＜0.01），第一次肌注吗啡的时间亦明显推迟。术后第6、12、24、36 h，试验组静息痛VAS评分显著小于对照组（ P＜0.01），术后24、36 h活动痛VAS评分亦显著小于对照组（ P＜0.01）。术后24 h引流量间接显示，试验组隐性失血量较对照组少（P＜0.01），患者主动直腿抬高时间、屈膝90°时间以及术后两周膝关节活动度比较，试验组均优于对照组（ P＜0.01）。两组在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测等方面进行比较，差异均无统计学意义，但试验组恶心呕吐发生率小于对照组。结论人工全膝关节置换术后膝周持续10％盐水冰袋冷敷，有助于减少术后麻醉镇痛剂消耗量，减轻术后早期疼痛，且可以有效减少隐性出血量，可促进膝关节功能恢复，且没有明显的不良反应。
目的：研究人工全膝關節置換術（ TKA）術後膝週持續冰袋加壓冷敷的鎮痛效果。方法2011年5月至2012年5月，將本組86例欲行單側TKA的骨關節炎患者隨機分成兩組：試驗組于TKA術後將毛巾包裹的10％鹽水冰袋置于膝前、內、外側冷敷，持續24 h；對照組給予同等規格的常溫軟包裝鹽水袋置于膝前、內、外側外敷，持續48 h；兩組均于術後第2天拔除引流管。術後24 h內兩組患者均經靜脈鎮痛泵滴註嗎啡行自控鎮痛（PCA），疼痛難以忍受時予以肌註嗎啡5～10 mg。通過比較兩組患者術後膝關節靜息和活動痛視覺模擬（ VAS）評分、隱性失血量、嗎啡使用情況、主動直腿抬高時間、屈膝90°時間、膝關節活動度（ ROM）以及併髮癥來分析膝週持續冰袋冷敷的鎮痛效果。結果 TKA術後膝週持續冰袋冷敷的患者，其術後36 h內各時間段以及總的嗎啡消耗量明顯減少（P＜0.01），第一次肌註嗎啡的時間亦明顯推遲。術後第6、12、24、36 h，試驗組靜息痛VAS評分顯著小于對照組（ P＜0.01），術後24、36 h活動痛VAS評分亦顯著小于對照組（ P＜0.01）。術後24 h引流量間接顯示，試驗組隱性失血量較對照組少（P＜0.01），患者主動直腿抬高時間、屈膝90°時間以及術後兩週膝關節活動度比較，試驗組均優于對照組（ P＜0.01）。兩組在術後傷口愈閤、感染髮生率、血壓、心率、皮疹、呼吸抑製和尿潴留的鑑測等方麵進行比較，差異均無統計學意義，但試驗組噁心嘔吐髮生率小于對照組。結論人工全膝關節置換術後膝週持續10％鹽水冰袋冷敷，有助于減少術後痳醉鎮痛劑消耗量，減輕術後早期疼痛，且可以有效減少隱性齣血量，可促進膝關節功能恢複，且沒有明顯的不良反應。
목적：연구인공전슬관절치환술（ TKA）술후슬주지속빙대가압랭부적진통효과。방법2011년5월지2012년5월，장본조86례욕행단측TKA적골관절염환자수궤분성량조：시험조우TKA술후장모건포과적10％염수빙대치우슬전、내、외측랭부，지속24 h；대조조급여동등규격적상온연포장염수대치우슬전、내、외측외부，지속48 h；량조균우술후제2천발제인류관。술후24 h내량조환자균경정맥진통빙적주마배행자공진통（PCA），동통난이인수시여이기주마배5～10 mg。통과비교량조환자술후슬관절정식화활동통시각모의（ VAS）평분、은성실혈량、마배사용정황、주동직퇴태고시간、굴슬90°시간、슬관절활동도（ ROM）이급병발증래분석슬주지속빙대랭부적진통효과。결과 TKA술후슬주지속빙대랭부적환자，기술후36 h내각시간단이급총적마배소모량명현감소（P＜0.01），제일차기주마배적시간역명현추지。술후제6、12、24、36 h，시험조정식통VAS평분현저소우대조조（ P＜0.01），술후24、36 h활동통VAS평분역현저소우대조조（ P＜0.01）。술후24 h인류량간접현시，시험조은성실혈량교대조조소（P＜0.01），환자주동직퇴태고시간、굴슬90°시간이급술후량주슬관절활동도비교，시험조균우우대조조（ P＜0.01）。량조재술후상구유합、감염발생솔、혈압、심솔、피진、호흡억제화뇨저류적감측등방면진행비교，차이균무통계학의의，단시험조악심구토발생솔소우대조조。결론인공전슬관절치환술후슬주지속10％염수빙대랭부，유조우감소술후마취진통제소모량，감경술후조기동통，차가이유효감소은성출혈량，가촉진슬관절공능회복，차몰유명현적불량반응。
Objective To investigate the efficacy of the continuous pressure cold therapy for analgesia after total knee arthroplasty ( TKA) .Methods 86 patients who received unilateral TKA in our hospital from May 2011 to May 2012 were randomly divided into two groups: the knee surgical site was treated with 10%saline ice pack in the trial group , while it was treated with room temperature 10%saline pack in the control group .The drainage tube were removed on the second day .All the patients received the patient-controlled analgesia ( PCA ) for 48 h post operatively .All the data were assessed and compared between the two groups , including the visual analog scale ( VAS) for pain during activity and at rest , the hidden blood loss , the morphine consumption , the time of ability to perform an active straight leg raising , the time of ability to reach 90 degrees knee flexion , the range of motion and complications .Results The continuous pressure cold therapy after TKA significantly reduced the morphine consumption during the 0-36 h postoperative period and the total narcotic consumption , and it also delayed the initial use of the narcotic.The VAS scores at rest of the trial group at postoperative 6, 10, 24 and 36 h were significantly lower than that of the control group , and the VAS scores during activity of the trial group at postoperative 24, 36 h were significantly lower than that of the control group .The drainage volume of the trial group was significantly lower than that of the control group .The time of ability to perform an active straight leg raising and to actively reach 90 degrees knee flexion , as well as the ROM of the knee at the 15th postoperative day, were better in the trial group than those in the control group .There were no significant differences in the incidence of postoperative wound healing , infection, blood pressure, heart rate, rash, respiratory depression, and urine retention between the two groups .The incidence of nausea and vomiting of the trial group was lower than that of the control group .Conclusion The continuous pressure cold therapy can reduce the narcotic consumption and the hidden blood loss .It offers a better pain control method without apparent risks following TKA .
