解放军医药杂志
解放軍醫藥雜誌
해방군의약잡지
Medical & Pharmaceutical Journal of Chinese People's Liberation Army
2015年
9期
64-68
,共5页
焦顺成%申海波%杜立%曹立峰%王振堂
焦順成%申海波%杜立%曹立峰%王振堂
초순성%신해파%두립%조립봉%왕진당
关节成形术,置换%麻醉和镇痛%神经传导阻滞%塞来昔布%罗哌卡因
關節成形術,置換%痳醉和鎮痛%神經傳導阻滯%塞來昔佈%囉哌卡因
관절성형술,치환%마취화진통%신경전도조체%새래석포%라고잡인
Arthroplasty%replacement%Anesthesia and analgesia%Nerve block%Celecoxib%Ropivacaine
目的 探讨多模式超前镇痛在全膝关节置换术( total knee arthroplasty, TKA)围术期应用的临床效果.方法 选取我院2013年2月-2014年10月60例因膝关节骨性关节炎接受初次单侧TKA患者,随机分为鸡尾酒式局部浸润镇痛组(A组)、单次股神经阻滞镇痛组(B组)、传统静脉自控式镇痛泵镇痛组(C组),每组20例. 3组均采用静脉吸入复合全身麻醉. A、B组术前2 d及术后均予塞来昔布200 mg,每日2次口服,术后切口周围局部冷敷,同时A组术中给予鸡尾酒式镇痛药物局部浸润(罗哌卡因150 mg +肾上腺素0. 1 mg),B 组给予单次股神经阻滞(0. 375%罗哌卡因30 ml);C组仅术后给予静脉自控式镇痛泵(2μg/kg舒芬太尼+氟比洛芬酯100 mg)镇痛. 记录3组术后6 h、12 h、1 d、2 d、3 d、5 d、7 d膝关节疼痛视觉模拟评分( visual analogue scale, VAS) ,术后6 h、12 h、1 d、2 d、3d股四头肌肌力,术后1、2、3d膝关节活动度,吗啡追加量及镇痛相关不良事件发生情况. 结果 A组与B组在术后第6 h~5 d VAS评分均显著小于C组(P<0. 05). 术后6 h和12 h,3组股四头肌肌力比较差异均无统计学意义(P>0. 05);术后1~3 d,A组股四头肌肌力均显著高于B组(P<0. 05),A、B组与C组比较差异均无统计学意义(P>0. 05). 术后1 d,A组膝关节活动度显著大于C组(P<0. 05),B、C组比较差异无统计学意义(P>0. 05);术后1~3 d,A、B组膝关节活动度比较差异无统计学意义(P>0. 05),但均显著大于C组(P<0. 05). A、B组术后吗啡追加量比较差异无统计学意义(P>0. 05),但均显著少于C组(P<0. 05). A、B组镇痛相关不良事件发生率比较差异无统计学差异(P>0. 05),且均显著低于C组(P<0. 05). 结论 多模式超前镇痛模式可以取得较传统静脉自控式镇痛泵更好的镇痛效果,且镇痛相关不良事件发生少,有利于患者术后功能恢复.
目的 探討多模式超前鎮痛在全膝關節置換術( total knee arthroplasty, TKA)圍術期應用的臨床效果.方法 選取我院2013年2月-2014年10月60例因膝關節骨性關節炎接受初次單側TKA患者,隨機分為鷄尾酒式跼部浸潤鎮痛組(A組)、單次股神經阻滯鎮痛組(B組)、傳統靜脈自控式鎮痛泵鎮痛組(C組),每組20例. 3組均採用靜脈吸入複閤全身痳醉. A、B組術前2 d及術後均予塞來昔佈200 mg,每日2次口服,術後切口週圍跼部冷敷,同時A組術中給予鷄尾酒式鎮痛藥物跼部浸潤(囉哌卡因150 mg +腎上腺素0. 1 mg),B 組給予單次股神經阻滯(0. 375%囉哌卡因30 ml);C組僅術後給予靜脈自控式鎮痛泵(2μg/kg舒芬太尼+氟比洛芬酯100 mg)鎮痛. 記錄3組術後6 h、12 h、1 d、2 d、3 d、5 d、7 d膝關節疼痛視覺模擬評分( visual analogue scale, VAS) ,術後6 h、12 h、1 d、2 d、3d股四頭肌肌力,術後1、2、3d膝關節活動度,嗎啡追加量及鎮痛相關不良事件髮生情況. 結果 A組與B組在術後第6 h~5 d VAS評分均顯著小于C組(P<0. 05). 術後6 h和12 h,3組股四頭肌肌力比較差異均無統計學意義(P>0. 05);術後1~3 d,A組股四頭肌肌力均顯著高于B組(P<0. 05),A、B組與C組比較差異均無統計學意義(P>0. 05). 術後1 d,A組膝關節活動度顯著大于C組(P<0. 05),B、C組比較差異無統計學意義(P>0. 05);術後1~3 d,A、B組膝關節活動度比較差異無統計學意義(P>0. 05),但均顯著大于C組(P<0. 05). A、B組術後嗎啡追加量比較差異無統計學意義(P>0. 05),但均顯著少于C組(P<0. 05). A、B組鎮痛相關不良事件髮生率比較差異無統計學差異(P>0. 05),且均顯著低于C組(P<0. 05). 結論 多模式超前鎮痛模式可以取得較傳統靜脈自控式鎮痛泵更好的鎮痛效果,且鎮痛相關不良事件髮生少,有利于患者術後功能恢複.
목적 탐토다모식초전진통재전슬관절치환술( total knee arthroplasty, TKA)위술기응용적림상효과.방법 선취아원2013년2월-2014년10월60례인슬관절골성관절염접수초차단측TKA환자,수궤분위계미주식국부침윤진통조(A조)、단차고신경조체진통조(B조)、전통정맥자공식진통빙진통조(C조),매조20례. 3조균채용정맥흡입복합전신마취. A、B조술전2 d급술후균여새래석포200 mg,매일2차구복,술후절구주위국부랭부,동시A조술중급여계미주식진통약물국부침윤(라고잡인150 mg +신상선소0. 1 mg),B 조급여단차고신경조체(0. 375%라고잡인30 ml);C조부술후급여정맥자공식진통빙(2μg/kg서분태니+불비락분지100 mg)진통. 기록3조술후6 h、12 h、1 d、2 d、3 d、5 d、7 d슬관절동통시각모의평분( visual analogue scale, VAS) ,술후6 h、12 h、1 d、2 d、3d고사두기기력,술후1、2、3d슬관절활동도,마배추가량급진통상관불량사건발생정황. 결과 A조여B조재술후제6 h~5 d VAS평분균현저소우C조(P<0. 05). 술후6 h화12 h,3조고사두기기력비교차이균무통계학의의(P>0. 05);술후1~3 d,A조고사두기기력균현저고우B조(P<0. 05),A、B조여C조비교차이균무통계학의의(P>0. 05). 술후1 d,A조슬관절활동도현저대우C조(P<0. 05),B、C조비교차이무통계학의의(P>0. 05);술후1~3 d,A、B조슬관절활동도비교차이무통계학의의(P>0. 05),단균현저대우C조(P<0. 05). A、B조술후마배추가량비교차이무통계학의의(P>0. 05),단균현저소우C조(P<0. 05). A、B조진통상관불량사건발생솔비교차이무통계학차이(P>0. 05),차균현저저우C조(P<0. 05). 결론 다모식초전진통모식가이취득교전통정맥자공식진통빙경호적진통효과,차진통상관불량사건발생소,유리우환자술후공능회복.
Objective To investigate the effect of multi-mode preemptive analgesia on patients undergoing total knee arthroplasty ( TKA) during perioperative period. Methods A total of 60 osteoarthrosis of knee patients undergoing the first unilateral TKA during February 2013 and October were randomly divided into local infiltration analgesia group (group A, n=20), a single femoral nerve block analgesia group (group B, n=20) and traditional self-control venous pump analgesia group (group C, n=20). All patients received complex intravenous inhalation anesthesia. Group A and B were treated with 200 mg Celecoxib (2/d) orally 2 d before and after the TKA, and then local incision cold compress was performed after the surgery;at the same time, group A was given local infiltration analgesia (150 mg Ropivacaine +0. 1 mg Epinephrine);group B were given a single femoral nerve block analgesia (0. 375% Ropivacaine, 30 ml);group C was given venous pump analgesia ( 2 μg/kg Sufentanil + 100 mg Flurbiprofen Axetil ) . the visual analogue scale ( VAS) scores of knee joints at 6 h, 12 h, 1 d, 2 d, 3 d, 5 d and 7 d after the surgery, quadriceps femoris muscle power at 6 h, 12 h, 1 d, 2 d and 3 d after the surgery, genual range-of-motion ( ROM) at 1 d, 2 d and 3 d after the surgery, superaddition doses of Morphine and incidence rate of adverse events related analgesia in the three groups were recorded. Results The VAS scores at postoperative 6 h, 12 h, 1 d, 2 d, 3 d and 5d in group A and B were significantly decreased than those in group C (P<0. 05). The differences of quadriceps femoris muscle power at postoperative 6 h and 12 h were not statistically significant in the three groups (P>0. 05);the values of quadriceps femoris muscle power at postoperative 1 d, 2 d and 3 d in group A were significantly higher than those in group B (P<0. 05), but the differences in the values between group A and B with group C were not statistically significant (P<0. 05). The value of genual ROM at postopera-tive 1 d in group A was significantly higher than that in group C ( P<0. 05 ) , but the difference in the value between group B and C was not statistically significant (P>0. 05); the differences in genual ROM values at postoperative 1 d, 2 d and 3 d between group A and B were not statistically significant (P>0. 05), but the values in group A and B were all significantly higher than those in group C ( P<0. 05 ) . The difference in superaddition doses of Morphine between group A and B were not statistically significant (P>0. 05), and the values in group A and B were all significantly less than that in group C (P<0. 05). The difference in incidence rate of adverse events related analgesia between group A and B was not statistically significant (P>0. 05), and the rates in group A and B were all significantly lower than that in group C ( P<0. 05 ) . Conclusion Multi-mode preemptive analgesia has better effective than traditional venous pump analgesia with lower incidence rate of adverse events and better post-operation function recovery.
