CAJ | 학술논문

背景:全膝关节置换围手术期疼痛处理一直为临床所关注,部分国内医院已经开展多模式镇痛治疗和其他综合围手术期镇痛措施,并报道取得了较好临床效果,但仍缺乏系统化的围手术期疼痛控制方案. 目的:通过比较多模式与非多模式两种镇痛方案在围手术期疼痛控制方面的短期临床效果,探索较为有效、规范的围手术期镇痛方案. 方法:随机选取2010年10月至2011年10月首都医科大学附属北京朝阳医院接受单侧初次全膝关节置换患者40例.并按照镇痛方案的不同分为多模式镇痛组20例及非多模式镇痛组20例.非多模式镇痛组采取常规的持续硬膜外镇痛,并在置换后给予非类固醇类消炎镇痛药物.多模式镇痛组则进行超前镇痛,置换后留置股神经阻滞管进行初期持续、后期负荷剂量镇痛. 结果与结论:多模式镇痛组患者置换后6,12,24 h的疼痛目测类比评分均值小于非多模式镇痛组,然而差异无显著性意义(P>0.05).置换后第2天多模式镇痛组活动痛要明显小于非多模式镇痛组,差异有显著性意义(P<0.01).置换后第3-7天多模式镇痛组患者静息痛及活动痛均小于非多模式镇痛组,差异有显著性意义(P<0.01).置换后第2-7天多模式镇痛组患者膝关节活动度均值大于非多模式镇痛组,差异有显著性意义(P<0.05).结果可见采用多模式疼痛控制方案能够在置换后短期内减少疼痛,加快关节功能的恢复.
배경:전슬관절치환위수술기동통처리일직위림상소관주,부분국내의원이경개전다모식진통치료화기타종합위수술기진통조시,병보도취득료교호림상효과,단잉결핍계통화적위수술기동통공제방안. 목적:통과비교다모식여비다모식량충진통방안재위수술기동통공제방면적단기림상효과,탐색교위유효、규범적위수술기진통방안. 방법:수궤선취2010년10월지2011년10월수도의과대학부속북경조양의원접수단측초차전슬관절치환환자40례.병안조진통방안적불동분위다모식진통조20례급비다모식진통조20례.비다모식진통조채취상규적지속경막외진통,병재치환후급여비류고순류소염진통약물.다모식진통조칙진행초전진통,치환후류치고신경조체관진행초기지속、후기부하제량진통. 결과여결론:다모식진통조환자치환후6,12,24 h적동통목측류비평분균치소우비다모식진통조,연이차이무현저성의의(P>0.05).치환후제2천다모식진통조활동통요명현소우비다모식진통조,차이유현저성의의(P<0.01).치환후제3-7천다모식진통조환자정식통급활동통균소우비다모식진통조,차이유현저성의의(P<0.01).치환후제2-7천다모식진통조환자슬관절활동도균치대우비다모식진통조,차이유현저성의의(P<0.05).결과가견채용다모식동통공제방안능구재치환후단기내감소동통,가쾌관절공능적회복.
BACKGROUND:Clinicians have pay more and more attention to the perioperative pain relief recently, and some domestic hospitals have been carried out multi-modal analgesic therapy and other perioperative analgesic measures and gained remarkable achievement, but systematic perioperative pain relieve protocol is stil deficient in most of the hospitals. @@@@OBJECTIVE:To compare the short term clinical effects of the perioperative pain relief protocol between the multimodal and the non-multimodal pain relief protocols, and to investigate the more effective and normative perioperative pain relief protocol. @@@@METHODS:From October 2010 to October 2011, forty patients who undertook the primary total knee arthroplasty in the Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University were selected, and randomly divided into two groups according to different pain relief protocols:multimodal pain control group (n=20) and non-multimodal pain control group (n=20). Patients in the non-multimodal group adopted the conventional epidural control analgesia, and oral y took non-steroidal anti-inflammatory drugs after the operation. However, the patients in the multimodal pain control group received the pre-emptive analgesia and femoral nerve block tube would also be done for the initial sustained and post-loading dose analgesia. @@@@RESULTS AND CONCLUSION:The visual analog scale scores in the multimodal pain control group were lower than those in the non-multimodal pain control group at 6, 12 and 24 hours after operation, but there was no significant difference of the visual analog scale score between the two groups (P>0.05). The activity pain in multimodal pain control group was lower than that in the non-multimodal pain control group at 2 days after operation, and the difference was significant between the two groups (P<0.01). From the third day to the seventh day, the activity and rest pain in multimodal pain control group were lower than those in non-multimodal pain control group, and there was significant difference between two groups (P<0.01). From the second day to the seventh day, range of motion of the knee joint in the multimodal pain control group was bigger than that in the non-multimodal pain control group, and the difference was significant between the two groups (P<0.05). The multimodal pain control protocol can relieve the perioperative pain of the total knee arthroplasty effectively in short term, and can lead to a quick functional recover in patients.