本文選題：關(guān)節(jié)成形術(shù)　切入點(diǎn)：置換　出處：《中國組織工程研究》2017年31期

【摘要】：背景:對全膝關(guān)節(jié)置換患者疼痛的處理一直是臨床治療中關(guān)注的重點(diǎn),尋找安全有效的鎮(zhèn)痛方法是外科醫(yī)生臨床研究及工作的重要任務(wù)。目的:對比股神經(jīng)阻滯自控鎮(zhèn)痛與自控硬膜外鎮(zhèn)痛對全膝關(guān)節(jié)置換患者圍術(shù)期應(yīng)激反應(yīng)及血流動力學(xué)的影響。方法:選擇2012年8月到2016年1月在海南醫(yī)學(xué)院第一附屬醫(yī)院進(jìn)行單側(cè)全膝關(guān)節(jié)置換的患者60例,根據(jù)入院順序分為觀察組與對照組,每組30例。全膝關(guān)節(jié)置換手術(shù)由同一組高年資醫(yī)生完成,均采用標(biāo)準(zhǔn)的全膝關(guān)節(jié)置換,對照組采用自控硬膜外鎮(zhèn)痛,觀察組采用股神經(jīng)阻滯自控鎮(zhèn)痛。觀察2組預(yù)后、圍置換期應(yīng)激反應(yīng)及血管活性物質(zhì)變化情況。結(jié)果與結(jié)論:(1)觀察組術(shù)后4,24,48 h的應(yīng)激目測類比評分均顯著低于對照組(P0.05);(2)觀察組術(shù)后24,48 h血清5-羥色胺質(zhì)量濃度均顯著低于對照組(P0.05);(3)2組術(shù)前患肢美國膝關(guān)節(jié)協(xié)會評分差異無顯著性意義,術(shù)后均呈現(xiàn)明顯增加的趨勢(P0.05),同時(shí)觀察組術(shù)后1,3個月的美國膝關(guān)節(jié)協(xié)會評分顯著高于對照組(P0.05);(4)觀察組術(shù)后3個月的呼吸抑制、尿潴留、肺不張、皮膚瘙癢、惡心嘔吐等并發(fā)癥發(fā)生情況明顯少于對照組(P0.05);(5)結(jié)果提示,相對于自控硬膜外鎮(zhèn)痛,股神經(jīng)阻滯自控鎮(zhèn)痛應(yīng)用于全膝關(guān)節(jié)置換圍手術(shù)期能緩解應(yīng)激疼痛反應(yīng),降低5-羥色胺的表達(dá),減少并發(fā)癥的發(fā)生,從而促進(jìn)患者關(guān)節(jié)功能的恢復(fù)。
[Abstract]:Background: the treatment of pain in patients with total knee arthroplasty has been the focus of clinical treatment. It is an important task for surgeons to find safe and effective analgesic methods. Objective: to compare the perioperative stress response and blood flow of patient-controlled analgesia by femoral nerve block and patient-controlled epidural analgesia in patients undergoing total knee arthroplasty. Methods: from August 2012 to January 2016, 60 patients underwent unilateral total knee arthroplasty in the first affiliated Hospital of Hainan Medical College. According to the order of admission, the patients were divided into observation group and control group with 30 cases in each group. Total knee arthroplasty was performed by an elderly doctor in the same group, and standard total knee arthroplasty was performed in the control group. The control group was treated with self-controlled epidural analgesia. The patient controlled analgesia with femoral nerve block was used in the observation group, and the prognosis of the two groups was observed. Results and conclusion the stress visual analogue scores of the observation group at 24 hours after operation were significantly lower than those of the control group (P < 0.05); the serum 5-hydroxytryptamine concentration in the observation group was significantly lower than that in the control group at 2448 hours after operation. There was no significant difference in the score of the American knee Association (AJA) between the two groups before operation, which was lower than that in the control group (P 0.05). At the same time, the scores of the American knee Association at 1 and 3 months after operation in the observation group were significantly higher than those in the control group (P 0.05 / 4)) the respiratory inhibition, urinary retention, atelectasis, pruritus and pruritus in the observation group were significantly higher than those in the control group 3 months after operation. The incidence of nausea and vomiting was significantly lower than that of the control group (P 0.05). The results indicated that compared with the patient controlled epidural analgesia, patient-controlled analgesia with femoral nerve block could relieve the stress pain response in the perioperative period of total knee arthroplasty. Reduce the expression of 5-hydroxytryptamine, reduce the incidence of complications, thus promoting the recovery of joint function in patients.
【作者單位】： 海南醫(yī)學(xué)院第一附屬醫(yī)院麻醉科;
【基金】：海南省自然科學(xué)基金項(xiàng)目(813189):炎癥因子調(diào)節(jié)圍手術(shù)期老年病人血糖代謝對術(shù)后認(rèn)知功能的影響~~
【分類號】：R614
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本文編號：1684174