本文選題：鎮(zhèn)痛　切入點(diǎn)：髓腔內(nèi)注射　出處：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:分析髓腔內(nèi)注射鎮(zhèn)痛合劑對人工全髖關(guān)節(jié)置換術(shù)(Total Hip Arthroplasty,THA)患者術(shù)后鎮(zhèn)痛的治療效果。方法:收集2014年9月-2016年12月間在本院骨外科接受THA治療的102例患者,分為對照組(A組,53例),常規(guī)口服鎮(zhèn)痛藥物;實(shí)驗(yàn)組(B組49例),在常規(guī)口服鎮(zhèn)痛藥物的基礎(chǔ)上術(shù)中行髓腔內(nèi)注射鎮(zhèn)痛合劑。術(shù)后檢測血常規(guī),測定血小板(Platelets,PLT)、中性粒細(xì)胞計(jì)數(shù)(Neutrophils,NEUT)、淋巴細(xì)胞計(jì)數(shù)(Lymphocyte Count,LC),計(jì)算中性粒細(xì)胞與淋巴細(xì)胞比值(Neutrophils to Lymphocyte Ratio,NLR)和血小板與淋巴細(xì)胞比值(Platelet to Lymphocyte Ratio,PLR),比較兩組的測定結(jié)果,分析各指標(biāo)間的相關(guān)性,·析NLR與PLR對治療效果的判定意義。檢測兩組患者術(shù)前術(shù)后的C-反應(yīng)蛋白(C-Reactive Protein,CRP)、D-二聚體(D-Dimmer)、二氧化碳分壓(Partial Pressure of Carbon Dioxide,PCO2),記錄兩組患者術(shù)前術(shù)后心率、呼吸頻率、血壓等—般情況。于術(shù)后不同時(shí)間段(12h、24h、48h、72h,1w、2w)及隨訪時(shí)(1個(gè)月、3個(gè)月)在靜息和活動(dòng)兩種狀態(tài)下進(jìn)行VAS評分、髖關(guān)節(jié)Harris評分,并記錄。隨訪1個(gè)月、3個(gè)月做Barthel評分;記錄術(shù)后髖關(guān)節(jié)活動(dòng)情況;記錄患者手術(shù)時(shí)間、住院總費(fèi)用,記錄不良反應(yīng)發(fā)生等情況。結(jié)果:兩組患者術(shù)后PLR的ROC曲線:曲線下面積:0.629(P0.05),敏感(sensitivity)0.458,特異度(specificity):0.811,切點(diǎn)值:PLR=194.53。A組患者手術(shù)后與手術(shù)前的CRP差值、D-Dimmer差值、Pco2差值均顯著高于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.001);A組患者術(shù)后的CRP值、D-Dimmer值、Pco2值均顯著高于術(shù)前,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。兩組患者術(shù)后12h、24h、48h和72hVAS評分均有統(tǒng)計(jì)學(xué)差異(P0.05);B組術(shù)后Harris評分均較A組高,兩組患者術(shù)后72h、1w、2w Harris評分,術(shù)后隨訪1個(gè)月、3個(gè)月Barthel評分均具有統(tǒng)計(jì)學(xué)差異(P0.05)。B組患者開始主動(dòng)活動(dòng)時(shí)間均較A組短,各項(xiàng)主動(dòng)活動(dòng)時(shí)間均具有統(tǒng)計(jì)學(xué)差異意義(P0.05);術(shù)后24h內(nèi),兩組患者髖關(guān)節(jié)主、被動(dòng)狀態(tài)下屈曲度分別達(dá)45°的例數(shù)進(jìn)行比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組患者手術(shù)后與手術(shù)前呼吸頻率、心率、血壓差值均顯著高于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.001);A組患者術(shù)后呼吸頻率、心率、血壓均顯著高于術(shù)前,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。發(fā)生各項(xiàng)不良反應(yīng)的例數(shù)進(jìn)行比較,兩組患者間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:采用髓腔內(nèi)注射鎮(zhèn)痛合劑對THA患者術(shù)后鎮(zhèn)痛治療,安全可靠,無明顯的藥物不良反應(yīng)發(fā)生。可有效降低下肢深靜脈血栓、冠心病等圍手術(shù)期并發(fā)癥的發(fā)生率。可有效降低術(shù)后疼痛恐懼心理,利于術(shù)后康復(fù)鍛煉。
[Abstract]:Objective: to analyze the effect of intramedullary injection analgesia mixture on postoperative analgesia in patients undergoing total Hip arthroplasty. Methods: 102 patients who received THA in bone surgery from September 2014 to December 2016 were collected. Group A was divided into control group (n = 53), group A (n = 53), group B (n = 49), group B (n = 49) received intramedullary intramedullary analgesic injection on the basis of routine oral analgesic drugs, and blood routine was detected after operation. Platelet count, neutrophil neutrophil count, lymphocyte count, neutrophils to Lymphocyte ratiotrophil (NLR) and platelet to lymphocyte ratio (Platelet to Lymphocyte RatioPLR) were measured, and the results were compared between the two groups. To analyze the correlation between the indexes, to analyze the significance of NLR and PLR in determining the therapeutic effect, to detect the C-reactive protein (C-Reactive protein), C-Reactive protein (CRP), D-Dimmerium, partial Pressure of Carbon dioxide-PCO2, and to record the heart rate and respiratory rate before and after operation in the two groups. Blood pressure and so on. VAS score, Harris score of hip joint were performed at different time after operation (12h / 24h / 48h / 72h / 1w / 2w) and follow-up (1 month, 3 months) respectively, and recorded. Follow up for 1 month, 3 months for Barthel score; Record the hip joint movement after operation, the time of operation, the total cost of hospitalization, Results: the ROC curves of PLR in two groups were as follows: the area under the curve was 0. 629, P 0. 05, sensitivity was 0. 458, specificity was 0. 811, and the cut point value was 194.53.A, the D-Dimmer difference was significantly higher than that in group B, and the difference of D-Dimmer was significantly higher than that in group B (P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05, P < 0. 05). There was significant difference in CRP and D-Dimmer and Pco2 in group A (P 0.001), and the difference was statistically significant (P 0.001). The Harris scores in group B were significantly higher than those in group A (P 0.05), and the scores of 72hVAS were significantly higher in group B than in group A at 12 hours after operation. The patients in the two groups were followed up for 1 month at 72 hours and 1 week after operation. The Barthel scores in group B were significantly shorter than those in group A (P 0.05), and the time of active activity in group B was significantly different from that in group A (P 0.05), and within 24 hours after operation, there was no significant difference between the two groups in the time of active activity (P 0.05). There were significant differences in respiratory frequency, heart rate and blood pressure difference between group A and group B after operation and before operation in patients with active and passive hip flexion (45 擄), the difference was significantly higher than that in group B (P 0.05), and the difference between group A and group A was significantly higher than that in group B. The postoperative respiratory frequency, heart rate and blood pressure in group A were significantly higher than those before operation, and the difference was statistically significant (P 0.001). Conclusion: intramedullary analgesia mixture for postoperative analgesia in patients with THA is safe and reliable, no obvious adverse drug reactions occur, and can effectively reduce deep venous thrombosis of lower extremity. The incidence of perioperative complications of coronary heart disease can effectively reduce postoperative pain and fear and is beneficial to postoperative rehabilitation and exercise.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李崗;陳小林;陳小妹;童美勉;;地佐辛+托烷司瓊靜脈鎮(zhèn)痛用于老年髖關(guān)節(jié)置換術(shù)后患者的效果觀察[J];臨床合理用藥雜志;2017年05期

2 段虹昊;馬建兵;李輝;肖琳;趙光輝;郭浩;;全膝關(guān)節(jié)置換術(shù)中氨甲環(huán)酸不同用法的療效與安全性研究[J];實(shí)用骨科雜志;2017年01期

3 白左明;;膝關(guān)節(jié)置換術(shù)多模式聯(lián)合鎮(zhèn)痛中雞尾酒注射療法對術(shù)后鎮(zhèn)痛效果的影響[J];中國藥物與臨床;2016年12期

4 孔祥朋;任鵬;倪明;李想;陳繼營;柴偉;;全膝關(guān)節(jié)置換術(shù)中三階段關(guān)節(jié)腔周圍注射雞尾酒與股神經(jīng)阻滯鎮(zhèn)痛效果的比較[J];中國骨與關(guān)節(jié)雜志;2016年10期

5 李金潔;王云蕓;趙英;潘振祥;李仁淑;;雞尾酒療法對老年全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的影響[J];中國老年學(xué)雜志;2016年15期

6 葉文秀;;多模式鎮(zhèn)痛在全膝關(guān)節(jié)置換術(shù)中的療效分析[J];實(shí)用臨床醫(yī)藥雜志;2016年08期

7 戴繁林;張鵬;時(shí)曉亞;田大為;王小武;符培亮;吳海山;;全膝關(guān)節(jié)置換術(shù)中注射雞尾酒式鎮(zhèn)痛混合劑對膝關(guān)節(jié)中期功能的影響[J];中國骨與關(guān)節(jié)損傷雜志;2016年04期

8 譚正龍;覃俊;羅起恩;黃英明;韓中金;;后外側(cè)切口人工全髖關(guān)節(jié)置換術(shù)50例報(bào)道[J];中國醫(yī)藥指南;2016年10期

9 劉剛;袁東堂;于廣洋;劉衛(wèi)東;郝躍東;趙則雪;;髖關(guān)節(jié)置換術(shù)后中位生存時(shí)間及相關(guān)預(yù)后影響因素分析[J];實(shí)用骨科雜志;2016年01期

10 周斌;馮玉旭;陳福揚(yáng);徐國浩;;“雞尾酒”療法治療全膝關(guān)節(jié)置換術(shù)后疼痛23例分析[J];實(shí)用骨科雜志;2015年09期

相關(guān)碩士學(xué)位論文 前1條

1 張燦洪;髖關(guān)節(jié)置換術(shù)使用骨水泥與術(shù)后關(guān)節(jié)疼痛關(guān)系探討[D];福建醫(yī)科大學(xué);2014年

，

本文編號：1680430