本文關(guān)鍵詞： 多模式鎮(zhèn)痛 超前鎮(zhèn)痛 連續(xù)股神經(jīng)阻滯 全膝關(guān)節(jié)置換術(shù)　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過前瞻性隨機(jī)對(duì)照臨床研究,研究以連續(xù)股神經(jīng)阻滯為中心的多模式鎮(zhèn)痛對(duì)初次全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛及早期膝關(guān)節(jié)功能康復(fù)的影響。方法：本研究所有病例來自2015年7月-2016年3月廣東省中醫(yī)院大學(xué)城骨科住院部,同時(shí)按照本研究的病例納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),錄入44例初次全膝關(guān)節(jié)置換病例,隨機(jī)分組分為A組22例(實(shí)驗(yàn)組)：連續(xù)股神經(jīng)阻滯聯(lián)合常規(guī)鎮(zhèn)痛方案。B組22例(對(duì)照組)：常規(guī)鎮(zhèn)痛方案。常規(guī)鎮(zhèn)痛方案：患者術(shù)前48小時(shí)給予塞來昔布口服(用法：每日兩次,每次200毫克),縫皮前于膝關(guān)節(jié)腔行關(guān)節(jié)周圍局部阻滯,術(shù)后72小時(shí)內(nèi)予特耐靜脈推注(每12小時(shí)一次,每次40毫克),之后改為塞來昔布口服(用法：每日兩次,每次200毫克)。術(shù)后當(dāng)天予燈盞花素注射劑靜滴(用法：50mg加入0.9%氯化鈉250m1,每天1次,持續(xù)7天),術(shù)后第2天消腫止痛膏外敷(用法：外敷術(shù)側(cè)胭窩,每次6小時(shí),持續(xù)7天)。根據(jù)鎮(zhèn)痛效果、膝關(guān)節(jié)活動(dòng)度、膝關(guān)節(jié)評(píng)分、總體滿意度、補(bǔ)救性鎮(zhèn)痛藥物、不良反應(yīng)來進(jìn)行評(píng)估,然后完成既定觀察指標(biāo)的資料收集。所有數(shù)據(jù)經(jīng)SPSS18.0進(jìn)行分析,通過檢驗(yàn)兩組觀察指標(biāo)的差異性,最后得出結(jié)論并進(jìn)行相關(guān)分析。結(jié)果：比較兩組鎮(zhèn)痛方案,鎮(zhèn)痛效果方面：兩組鎮(zhèn)痛方案處理后疼痛評(píng)分隨著時(shí)間變化均有下降,以連續(xù)股神經(jīng)阻滯為中心的鎮(zhèn)痛方案組的術(shù)后疼痛評(píng)分在大部分時(shí)間點(diǎn)比常規(guī)鎮(zhèn)痛方案組低；膝關(guān)節(jié)活動(dòng)度方面：兩組鎮(zhèn)痛方案處理后膝關(guān)節(jié)活動(dòng)度隨著時(shí)間變化均有增高,以連續(xù)股神經(jīng)阻滯為中心的鎮(zhèn)痛方案組的術(shù)后膝關(guān)節(jié)活動(dòng)度在各個(gè)時(shí)間點(diǎn)比常規(guī)鎮(zhèn)痛方案組高；膝關(guān)節(jié)評(píng)分方面：實(shí)驗(yàn)組術(shù)后1周的HSS評(píng)分高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；兩組患者的出院總體滿意度、補(bǔ)救性鎮(zhèn)痛藥物使用率、不良反應(yīng)發(fā)生率均無明顯相關(guān)性,無統(tǒng)計(jì)學(xué)意義(P＞0.05)結(jié)論：實(shí)驗(yàn)組早期靜息時(shí)及活動(dòng)后的疼痛程度低于對(duì)照組,實(shí)驗(yàn)組早期膝關(guān)節(jié)主動(dòng)及被動(dòng)活動(dòng)度均高于對(duì)照組,實(shí)驗(yàn)組術(shù)后1周的HSS評(píng)分高于對(duì)照組,提示以連續(xù)股神經(jīng)阻滯為中心的多模式鎮(zhèn)痛方案相比常規(guī)鎮(zhèn)痛方案具有優(yōu)勢(shì),能較好地滿足患者全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛及早期膝關(guān)節(jié)功能康復(fù)的要求。
[Abstract]:Objective: to adopt prospective randomized controlled clinical study, To study the effect of multimode analgesia with continuous femoral nerve block on analgesia and early rehabilitation of knee joint after primary total knee arthroplasty. Methods: from July 2015 to March 2016 in Guangdong Province, we studied the effects of continuous femoral nerve block on analgesia and early rehabilitation of knee joint. Department of Orthopaedics, University City, At the same time, 44 cases of initial total knee replacement were recorded according to the inclusion criteria and exclusion criteria of this study. Group A (n = 22) were randomly divided into two groups: group A (n = 22): continuous femoral nerve block combined with conventional analgesia, group B (n = 22) (control group: conventional analgesia regimen). Routine analgesia regimen: patients were given celecoxib orally 48 hours before operation (administration: twice a day). 200 mg / time, periarticular local block before suture skin was performed in knee joint cavity, intravenous injection (40 mg / time, every 12 hours) was given within 72 hours after operation, and then celecoxib was given orally (twice a day, twice a day). On the day after operation, breviscapine injection was given intravenously with 0.9% sodium chloride 250ml, once a day, lasting 7 days. The second day after operation, detumescent analgesic ointment was applied externally (usage: external application of popliteal fossa, 6 hours each time). They were evaluated according to analgesic effects, knee motion, knee joint score, overall satisfaction, remedial analgesic drugs, adverse reactions, and then collected from established observation indicators. All data were analyzed by SPSS18.0. By examining the difference of observation indexes between the two groups, the conclusion was drawn and the correlation analysis was carried out. Results: comparing the analgesic schemes between the two groups, the analgesic effect of the two groups: the pain scores of the two groups decreased with time after the treatment of the two groups of analgesic schemes. The postoperative pain score of the analgesic group with continuous femoral nerve block as the center was lower than that of the routine analgesia group at most time points. The postoperative knee motion of the analgesic group with continuous femoral nerve block was higher than that of the routine analgesia group at each time point, and the knee joint score of the experimental group was higher than that of the control group at 1 week after operation. The difference was statistically significant (P < 0.05), and there was no significant correlation between the two groups in terms of overall satisfaction, the utilization rate of remedial analgesic drugs and the incidence of adverse reactions. No statistical significance P > 0.05) conclusion: the degree of pain in the experimental group at early rest and after exercise is lower than that in the control group, the active and passive motion of knee joint in the experimental group is higher than that in the control group, and the HSS score in the experimental group is higher than that in the control group at 1 week after operation. It is suggested that the multi-mode analgesic regimen with continuous femoral nerve block as the center is superior to the conventional analgesic regimen and can meet the requirements of postoperative analgesia and early functional rehabilitation of knee joint after total knee arthroplasty.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.4

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