CAJ | 학술논문

背景：积极的人工全膝关节置换极大改善了膝关节退行性疾病患者的生活质量，但围置换期急性疼痛广泛存在，增加了并发症的发生概率，阻碍了患者的康复锻炼，因此围置换期疼痛处理成为当前膝关节置换的重要课题。 　　目的：观察比较包括帕瑞昔布钠超前镇痛、关节周围镇痛、帕瑞昔布钠超前镇痛与关节周围镇痛联合等方案在患者膝关节置换后镇痛中的疗效及安全性，探索合理有效的镇痛方案。 　　方法：随机选择江苏省徐州市中心医院在2012年5月至2014年12月收治的60例膝关节置换患者，通过随机数表法将其分为帕瑞昔布钠超前镇痛组、关节周围镇痛组、帕瑞昔布钠超前镇痛+关节周围镇痛组、空白对照组，每组15例，在膝关节置换中对患者实施不同的镇痛方案。 　　结果与结论：置换后6，12，24，36 h，与其他3组比较，帕瑞昔布钠超前镇痛+关节周围镇痛组各时间段的静息痛、活动痛疼痛评分及镇痛药物用量均显著降低(P <0.05)，置换后麻醉剂的使用时间间隔明显长于其他3组(P <0.05)。置换后3 d，与其他3组比较，内帕瑞昔布钠超前镇痛+关节周围镇痛组患者置换后的主动抬腿时间、主动屈膝90°时间显著缩短(P <0.05)，而膝关节活动度较好。帕瑞昔布钠超前镇痛+关节周围镇痛组患者在3组中不良反应发生率最低(P <0.05)。结果提示帕瑞昔布钠联合关节周围镇痛是一种安全可行的镇痛方案，能显著减少膝关节置换后疼痛，减少麻醉用量，患者置换后不良反应降低，有助于改善患者的关节活动度并促进患者早期康复。
배경：적겁적인공전슬관절치환겁대개선료슬관절퇴행성질병환자적생활질량，단위치환기급성동통엄범존재，증가료병발증적발생개솔，조애료환자적강복단련，인차위치환기동통처리성위당전슬관절치환적중요과제。 　　목적：관찰비교포괄파서석포납초전진통、관절주위진통、파서석포납초전진통여관절주위진통연합등방안재환자슬관절치환후진통중적료효급안전성，탐색합리유효적진통방안。 　　방법：수궤선택강소성서주시중심의원재2012년5월지2014년12월수치적60례슬관절치환환자，통과수궤수표법장기분위파서석포납초전진통조、관절주위진통조、파서석포납초전진통+관절주위진통조、공백대조조，매조15례，재슬관절치환중대환자실시불동적진통방안。 　　결과여결론：치환후6，12，24，36 h，여기타3조비교，파서석포납초전진통+관절주위진통조각시간단적정식통、활동통동통평분급진통약물용량균현저강저(P <0.05)，치환후마취제적사용시간간격명현장우기타3조(P <0.05)。치환후3 d，여기타3조비교，내파서석포납초전진통+관절주위진통조환자치환후적주동태퇴시간、주동굴슬90°시간현저축단(P <0.05)，이슬관절활동도교호。파서석포납초전진통+관절주위진통조환자재3조중불량반응발생솔최저(P <0.05)。결과제시파서석포납연합관절주위진통시일충안전가행적진통방안，능현저감소슬관절치환후동통，감소마취용량，환자치환후불량반응강저，유조우개선환자적관절활동도병촉진환자조기강복。
BACKGROUND:Positive total knee replacement surgery greatly improved the quality of life in patients with knee joint degenerative disease, but widespread perioperative acute pain increases the probability of complications and hinders the rehabilitation exercises of patients; therefore perioperative pain processing has become an important topic of the current knee replacement. OBJECTIVE:To compare the efficacy and safety of preemptive analgesia of parecoxib sodium, periarticular analgesia and their combination in the total knee arthroplasty, and explore reasonable and effective analgesic scheme. METHODS:60 patients undergoing knee replacement were randomly selected in Xuzhou Central Hospital from May 2012 to December 2014, and then they were divided with a random number table into four groups: preemptive analgesia with parecoxib sodium, periarticular analgesia, combination and blank control, with 15 cases in each group. Different programs were used in each group during total knee arthroplasty. RESULTS AND CONCLUSION:At 6, 12, 24 and 36 hours after operation, rest pain scores, activity pain scores and drug dose were significantly lower in the combination group than other three groups (P < 0.05). Time interval of anesthetic use was significantly longer in the combination group than other three groups (P < 0.05). At 3 days after replacement, active leg-raising time and active genuflex 90° time were significantly shorter in the combination group than other three groups (P < 0.05), and range of motion of the knee was good. The incidence of adverse reaction was lowest in the combination group (P < 0.05). These results indicate that preemptive analgesia of parecoxib sodium combined with periarticular analgesia is a safe and effective analgesic option, can obviously reduce pain after replacement, the amount of anesthetics and adverse reactions, improve range of motion of the knee and promote early rehabilitation of patients.