本文關(guān)鍵詞： 骨性關(guān)節(jié)炎 硬膜外鎮(zhèn)痛泵 雞尾酒療法 膝關(guān)節(jié)置換術(shù) 術(shù)后鎮(zhèn)痛　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:隨著經(jīng)濟社會的發(fā)展,人口老齡化的到來,越來越多的老年人患有骨性關(guān)節(jié)炎。骨性關(guān)節(jié)炎是一種退行性病變,由于年齡、肥胖、勞損、外傷等多種因素引起的關(guān)節(jié)軟骨退化損傷、關(guān)節(jié)邊緣和軟骨下骨反應性增生。臨床表現(xiàn)為緩慢發(fā)展的關(guān)節(jié)疼痛、壓痛、僵硬、關(guān)節(jié)腫脹、活動受限和關(guān)節(jié)畸形等。目前疾病中后期以人工膝關(guān)節(jié)置換術(shù)(TKA,Total knee arthroplasty)為主,也是目前治療骨性關(guān)節(jié)炎最有效的手段,能夠起到緩解疼痛、糾正關(guān)節(jié)畸形、恢復運動功能等目的,因而備受老年患者所青睞。然而,由于骨性關(guān)節(jié)炎患者年齡普遍較大,且TKA術(shù)后疼痛因素眾多,術(shù)后疼痛影響患者滿意度及關(guān)節(jié)功能康復。因此,術(shù)后疼痛管理成為不可回避的問題。目前臨床上有眾多鎮(zhèn)痛方案,但是尚無最理想的治療方案,本文通過回顧性研究,對硬膜外鎮(zhèn)痛泵聯(lián)合雞尾酒療法在初次人工膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛效果進行研究。目的:TKA圍手術(shù)期鎮(zhèn)痛方法較多,包括神經(jīng)阻滯,口服藥物,自控鎮(zhèn)痛泵等。本文通過術(shù)中在膝關(guān)節(jié)周圍軟組織內(nèi)注射混合鎮(zhèn)痛藥物(雞尾酒療法)及術(shù)后放置硬膜外鎮(zhèn)痛泵聯(lián)合鎮(zhèn)痛來控制膝關(guān)節(jié)置換術(shù)后的疼痛,減少患者不良反應,促進患者早期鍛煉膝關(guān)節(jié),提高膝關(guān)節(jié)置換術(shù)治療效果及患者滿意度。方法:選取60例行膝關(guān)節(jié)置換術(shù)治療的骨關(guān)節(jié)炎患者,按照隨機分配原則分為3組,每組患者20名。A組患者術(shù)中膝關(guān)節(jié)周圍軟組織注射混合鎮(zhèn)痛藥物及術(shù)后放置硬膜外鎮(zhèn)痛泵;B組患者只在術(shù)中關(guān)節(jié)周圍軟組織注射混合鎮(zhèn)痛藥物藥物;C組只在術(shù)后放置硬膜外鎮(zhèn)痛泵。觀察3組患者術(shù)后疼痛視覺模擬評分(VAS)、傷口感染、延期愈合及組織壞死并發(fā)癥。結(jié)果:三組患者術(shù)后靜息痛VAS評分、活動痛VAS評分相比較,差異具有統(tǒng)計學意義(P0.05)。靜息痛評分術(shù)后2h,4h,8h,12h,24h,36h,48h A組(聯(lián)合組)分數(shù)均低于B組和C組(P0.05);活動痛評分術(shù)后6h,12h,24h,36h,2d,3d,5d患者分數(shù)比較,A組分數(shù)也均低于B組和C組(P0.05)。無論何種鎮(zhèn)痛方式,患者靜息痛在術(shù)后24h達到最高峰,活動痛在術(shù)后36h達到最高峰。三組患者在術(shù)后切口感染、延期愈合、組織壞死等并發(fā)癥上均無統(tǒng)計學差異(P0.05)。結(jié)論:硬膜外鎮(zhèn)痛泵聯(lián)合雞尾酒療法對緩解膝關(guān)節(jié)置換術(shù)后疼痛具有積極作用,可以有效降低術(shù)后早期靜息痛和活動痛VAS評分;及時注意患者疼痛變化,為臨床上止痛藥增減提供幫助。聯(lián)合治療法不增加術(shù)后并發(fā)癥,促進患者早期進行功能鍛煉,關(guān)節(jié)功能的早期康復,有利于提高患者滿意度。
[Abstract]:Background: with the development of economy and society, the arrival of aging population, more and more elderly people suffer from osteoarthritis. Osteoarthritis is a degenerative disease, because of age, obesity, fatigue. Trauma and other factors caused by degeneration of articular cartilage injury, articular edge and subchondral bone reactive hyperplasia. Clinical manifestations of slow development of joint pain, tenderness, stiffness, joint swelling. At present, the main disease in the middle and late stage of the disease is total knee arthroplasty (TKAA Total knee arthroplasty). It is also the most effective treatment for osteoarthritis at present, which can relieve pain, correct joint deformity and restore motor function, so it is favored by elderly patients. Because the patients with osteoarthritis are generally older, and there are many pain factors after TKA, postoperative pain affects patients' satisfaction and rehabilitation of joint function. Postoperative pain management has become an unavoidable problem. At present, there are many clinical analgesic schemes, but there is no ideal treatment, this paper through a retrospective study. To study the analgesic effect of epidural analgesia pump combined with cocktail therapy after the first artificial knee arthroplasty. Objective to study the analgesic effect of TKA in perioperative period, including nerve block and oral drug. The pain after knee arthroplasty was controlled by intraoperative injection of mixed analgesic drugs (cocktail therapy) and placement of epidural analgesia pump combined with analgesia after knee arthroplasty. Methods: 60 cases of osteoarthritis treated by knee arthroplasty were selected. According to the principle of random distribution, the patients in each group were divided into 3 groups. 20 patients in group A were injected with mixed analgesic drugs around the knee joint during the operation and the epidural analgesia pump was placed after operation. Patients in group B were only injected with mixed analgesic drugs in periarticular soft tissue during the operation. Group C only placed epidural analgesia pump after operation. The visual analogue score of postoperative pain and wound infection were observed in three groups. Results: there were significant differences in VAS score and VAS score of resting pain and active pain between the three groups (P < 0.05). The scores of group A (combined group) were lower than those of group B and group C (P 0.05). The scores of group A were also lower than those of group B and group C (P 0.05), regardless of the analgesia mode. The rest pain reached the peak at 24 hours after operation and the activity pain reached the peak at 36 hours after operation. The infection of incision and delayed healing were observed in the three groups. There was no significant difference in complications such as tissue necrosis. Conclusion: epidural analgesia pump combined with cocktail therapy has a positive effect on relieving pain after knee arthroplasty. It can effectively reduce the VAS score of resting pain and active pain in the early postoperative period. Pay attention to the change of pain in time and provide help for the increase and decrease of analgesic drugs in clinic. Combined therapy does not increase postoperative complications and promote early functional exercise and early rehabilitation of joint function. It is beneficial to improve patients' satisfaction.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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