【摘要】：目的擬通過對(duì)比單次股神經(jīng)阻滯與切口局部浸潤(rùn)局麻藥這兩種鎮(zhèn)痛方法分別聯(lián)合口服非甾體抗炎藥及術(shù)后冷療所構(gòu)成的兩種多模式鎮(zhèn)痛方案在全膝關(guān)節(jié)置換術(shù)中的療效及對(duì)術(shù)后并發(fā)癥的影響，找到更佳的術(shù)后鎮(zhèn)痛方案。 方法從2012年2月至2013年6月，搜集在我科擬行初次在初次單側(cè)全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)的75例患者,均明確診斷為膝關(guān)節(jié)骨性關(guān)節(jié)炎（osteoarthritis，OA）。男性27例，，女性48例，患者年齡分布于53-81歲，其中女性均已絕經(jīng)。所有患者具有明確的手術(shù)指征并排除相關(guān)手術(shù)禁忌癥。運(yùn)用前瞻性、隨機(jī)性、對(duì)比研究方法在術(shù)前將75例患者隨機(jī)分為三組，各25例。單次股神經(jīng)阻滯組（F組）、局部浸潤(rùn)鎮(zhèn)痛組（L組）和靜脈鎮(zhèn)痛泵組（I組）。三組麻醉方式均為靜脈吸入復(fù)合全身麻醉。鎮(zhèn)痛方案為：F組：術(shù)前及術(shù)后口服塞來昔布膠囊與曲馬多緩釋片+麻醉后羅哌卡因與腎上腺素單次股神經(jīng)阻滯+術(shù)后冷療；L組：術(shù)前及術(shù)后口服塞來昔布膠囊和曲馬多緩釋片+術(shù)中局部浸潤(rùn)注射羅哌卡因與腎上腺素混合物+術(shù)后冷療；I組：術(shù)前不采取鎮(zhèn)痛措施，術(shù)后應(yīng)用靜脈鎮(zhèn)痛泵。記錄并比較三組患者術(shù)后膝關(guān)節(jié)疼痛視覺模擬評(píng)分法（visual analogue scale，VAS）分?jǐn)?shù)、嗎啡追加量、主動(dòng)直腿抬高至45°時(shí)間、主動(dòng)屈曲至90°時(shí)間、出院時(shí)膝關(guān)節(jié)活動(dòng)度（range of motion, ROM）、術(shù)后呼吸抑制、嘔吐、尿儲(chǔ)留的發(fā)生率。. 結(jié)果1. F組與L組相比，膝關(guān)節(jié)疼痛VAS評(píng)分、嗎啡消耗量、主動(dòng)直腿抬高至45°時(shí)間、主動(dòng)屈曲至90°時(shí)間、出院時(shí)膝關(guān)節(jié)ROM無明顯差異（P0.05），術(shù)后尿儲(chǔ)留、嘔吐發(fā)生率也相似（P0.05），且兩組患者均未出現(xiàn)呼吸抑制。2.與I組相比，F(xiàn)組和L組嗎啡追加量、術(shù)后前3天的膝關(guān)節(jié)疼痛VAS評(píng)分、主動(dòng)直腿抬高至45°時(shí)間、主動(dòng)屈曲至90°時(shí)間、術(shù)后呼吸抑制、嘔吐和尿儲(chǔ)留發(fā)生率均明顯下降和減少（P0.05），出院時(shí)膝關(guān)節(jié)ROM增加，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；而術(shù)后第4、5天，F(xiàn)組和L組與I組的膝關(guān)節(jié)疼痛VAS評(píng)分差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論1.單次股神經(jīng)阻滯和膝關(guān)節(jié)局部浸潤(rùn)鎮(zhèn)痛在TKA中的鎮(zhèn)痛效果相近，且均無明顯并發(fā)癥。2.羅哌卡因與腎上腺素單次股神經(jīng)阻滯+手術(shù)前后口服塞來昔布膠囊與曲馬多緩釋片+術(shù)后冷療所組成的多模式超前鎮(zhèn)痛方案，或是術(shù)中局部浸潤(rùn)注射羅哌卡因與腎上腺素混合物+手術(shù)術(shù)后口服塞來昔布膠囊和曲馬多緩釋片+術(shù)后冷療，均可取得較靜脈鎮(zhèn)痛泵更理想的鎮(zhèn)痛效果，減少術(shù)后嗎啡的使用量和相關(guān)副作用，促進(jìn)患者更早的進(jìn)行術(shù)后功能鍛煉，加快功能恢復(fù)。
[Abstract]:Objective to compare the curative effect and postoperative complications of two kinds of analgesic schemes, single thigh nerve block and incision local infiltration local anesthetic, combined with oral non-steroidal anti-inflammatory drugs and postoperative cold therapy, respectively, and to find a better postoperative analgesia scheme. Methods from February 2012 to June 2013, 75 patients with knee osteoarthritis (osteoarthritis,OA) were diagnosed as knee osteoarthritis (osteoarthritis,OA) for the first time in our department. There were 27 males and 48 females. The patients were 53 years old and 81 years old, all of them were menopausal. All patients have clear surgical indications and exclude related contraindications. Using prospective, random and comparative study, 75 patients were randomly divided into three groups, 25 patients in each group. Single thigh nerve block group (group F), local infiltration analgesia group (group L) and intravenous analgesia pump group (group I). All the three groups were anesthetized by intravenous inhalation combined with general anesthesia. The analgesic regimen was as follows: group F: cold therapy with ropivacaine and epinephrine after anesthesia with celecoxib capsule and tramadol sustained-release tablets before and after operation; group L: local infiltration injection of ropivacaine and epinephrine mixture before and after operation; group I: intravenous analgesia pump was not taken before operation. The scores of (visual analogue scale,VAS), morphine addition, active straight leg elevation to 45 擄time, active flexion to 90 擄time, and the incidence of respiratory suppression, vomiting and urine storage after (range of motion, ROM), were recorded and compared among the three groups. Results 1. Compared with group L, there was no significant difference in VAS score of knee joint pain, morphine consumption, active straight leg elevation to 45 擄, active flexion to 90 擄time, no significant difference in ROM of knee joint at discharge (P 0.05), and the incidence of postoperative urine storage and vomiting was similar (P 0.05), and there was no respiratory inhibition in both groups. 2. Compared with group I, the amount of morphine in group F and group L, the VAS score of knee joint pain, the time of active straight leg elevation to 45 擄, the time of active flexion to 90 擄, the incidence of postoperative respiratory suppression, vomiting and urinary storage decreased significantly in group F and L, and the ROM of knee joint increased at discharge (P 0.05). On the 4th and 5th day after operation, there was no significant difference in VAS score between group F, group L and group I (P 0.05). Conclusion 1. The analgesic effect of single thigh nerve block and knee joint local infiltration analgesia in TKA was similar, and there were no obvious complications. 2. The multi-mode preemptive analgesia regimen composed of ropivacaine and epinephrine single thigh nerve block before and after oral celecoxib capsule and tramadol sustained-release tablets after operation, or intraoperative local infiltration injection of ropivacaine and epinephrine mixture after operation, can achieve better analgesic effect than intravenous analgesia pump. Reduce postoperative morphine use and related side effects, promote patients to carry out postoperative functional exercise earlier, accelerate functional recovery.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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相關(guān)期刊論文 前1條

1 翁文杰;王鋒;張海林;蔣青;邱勇;;全膝關(guān)節(jié)置換術(shù)中關(guān)節(jié)周圍注射混合鎮(zhèn)痛液的療效觀察[J];中華關(guān)節(jié)外科雜志(電子版);2009年06期

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