CAJ | 학술논문

目的：探讨膝关节周围局麻药物注射联合静脉自控镇痛泵（PCIA）在全膝关节置换（TKA）术后镇痛的临床效果。方法2012年5月~6月，选择全身麻醉下膝关节骨性关节炎单侧TKA患者40例，随机分为研究组20例和对照组20例：研究组缝合伤口前关节局部注射0.5%罗哌卡因20ml+地塞米松10mg混合液；对照组局部注射等体积生理盐水，两组患者术后均应用静脉镇痛泵，持续使用48h。采用视觉类比评分法（VAS）评估术后两组患膝活动痛，记录术后4、8、12、24、48h的VAS评分，患者总体满意度及恶心、呕吐等不良反应。结果研究组术后4、8、12、24、48h，患膝活动时VAS评分小于对照组，差异有统计学意义（P＜0.01）；总体满意度明显高于对照组，差异有统计学意义（P＜0.01）；两组不良反应发生率低。结论膝关节周围局麻药物注射联合静脉自控镇痛泵多模式镇痛可明显减轻 TKA术后早期疼痛，镇痛效果满意，有利于术后早期膝关节活动、促进功能康复。
목적：탐토슬관절주위국마약물주사연합정맥자공진통빙（PCIA）재전슬관절치환（TKA）술후진통적림상효과。방법2012년5월~6월，선택전신마취하슬관절골성관절염단측TKA환자40례，수궤분위연구조20례화대조조20례：연구조봉합상구전관절국부주사0.5%라고잡인20ml+지새미송10mg혼합액；대조조국부주사등체적생리염수，량조환자술후균응용정맥진통빙，지속사용48h。채용시각류비평분법（VAS）평고술후량조환슬활동통，기록술후4、8、12、24、48h적VAS평분，환자총체만의도급악심、구토등불량반응。결과연구조술후4、8、12、24、48h，환슬활동시VAS평분소우대조조，차이유통계학의의（P＜0.01）；총체만의도명현고우대조조，차이유통계학의의（P＜0.01）；량조불량반응발생솔저。결론슬관절주위국마약물주사연합정맥자공진통빙다모식진통가명현감경 TKA술후조기동통，진통효과만의，유리우술후조기슬관절활동、촉진공능강복。
Objective To investigate the ef iciency of pain management post total knee arthroplasty (TKA) by periarticular local anesthetic injection combined patient-control ed intravenous analgesia (PCIA). Methods:From May 2012 to June 2012, 40 cases with unilateral knee osteoarthritis performed TKA under general anesthesia were included in this study. 40 cases were randomly divided into test group (20 knees) and a control group (20 knees). In the study group, compounds of 0.5%ropivacaine 20ml+dexamethasone 10mg were injected periarticular before the wound closure; while in the control group the same volume of normal saline were injected in similar method. Both groups underwent intravenous analgesia pump for 48h post TKA. Mobile visual analog score (VAS) at 4,8,12,24,48 hours post surgery, patient satisfaction and overal nausea, vomiting and other adverse reactions were recorded and analyzed. Results The study group had lower mobile VAS score at 4,8,12,24,48 hours post TKA than the control group (P<0.01). The overal satisfaction ratio was significantly higher and the adverse reactions were lower compared with the control group (P<0.01). Conclusion Periarticular local anesthetic injection combined intravenous analgesia pump can significantly reduce early mobile pain post TKA;it is benefit for early knee joint activities to promote functional recovery.