本文選題：冷療 + 鎮(zhèn)痛　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的:觀察間斷冷療在人工膝關(guān)節(jié)置換術(shù)后腫痛及關(guān)節(jié)活動(dòng)度的療效。方法:60例單側(cè)人工膝關(guān)節(jié)置換(TKA)病人隨機(jī)分為試驗(yàn)組30例和對(duì)照組30例,試驗(yàn)組術(shù)中關(guān)節(jié)周?chē)⑸洹半u尾酒”,硬膜外鎮(zhèn)痛泵自控及口服非甾體抗炎藥鎮(zhèn)痛,術(shù)后冰袋間斷冷療,對(duì)照組不給于冰袋冷療,余治療及功能鍛煉與治療組相同,分別記錄術(shù)前、術(shù)后6h、24h、48h、72h的運(yùn)動(dòng)痛評(píng)分(VAS),膝關(guān)節(jié)術(shù)前、術(shù)后1d、2d、3d、1w的關(guān)節(jié)活動(dòng)度(Range of Motion,ROM值),術(shù)后6h、24h、48h所有血性引流液總量(ml),術(shù)后并發(fā)癥及患者滿(mǎn)意度。結(jié)果:通過(guò)對(duì)兩組患者術(shù)前、術(shù)后不同時(shí)間點(diǎn)運(yùn)動(dòng)VAS值變化情況分析比較,兩者組內(nèi)比較,較術(shù)前差異有統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明鎮(zhèn)痛方案選擇有效,可減低TKA術(shù)后疼痛評(píng)分;而試驗(yàn)組與對(duì)照組比較,而冷療組疼痛改善較明顯,二者比較有統(tǒng)計(jì)學(xué)意義,這說(shuō)明冷療在鎮(zhèn)痛方面效果顯著。?兩組患者術(shù)后不同時(shí)間點(diǎn)關(guān)節(jié)活動(dòng)度比較,兩組組內(nèi)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),這說(shuō)明早期鎮(zhèn)痛效果顯著,關(guān)節(jié)及早得到有效地功能鍛煉,膝關(guān)節(jié)活動(dòng)范圍增大;而試驗(yàn)組膝與照組比較試驗(yàn)組優(yōu)于對(duì)照組,二者比較有統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明間斷冷療可改善膝關(guān)節(jié)早期活動(dòng)度。?通過(guò)對(duì)兩組術(shù)后6h、24h、48h引流量的分析,二者比較試驗(yàn)組優(yōu)于對(duì)照組,二者有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)通過(guò)對(duì)兩組患者副反應(yīng)分析,試驗(yàn)組無(wú)明顯相關(guān)并發(fā)癥出現(xiàn),說(shuō)明間斷冷療并不增加不良反應(yīng)的發(fā)生率。(5)兩組滿(mǎn)意率比較,試驗(yàn)組滿(mǎn)意率為93.33%,對(duì)照組滿(mǎn)意率為83.33%,差異有統(tǒng)計(jì)學(xué)意義,說(shuō)明間斷冷療可提高患者的滿(mǎn)意度。結(jié)論:間斷冷療可有效改善人工全膝關(guān)節(jié)術(shù)后疼痛、腫脹程度,改善關(guān)節(jié)活動(dòng)度,具有不良反應(yīng)小,臨床滿(mǎn)意度高的優(yōu)勢(shì),具有成本低廉,操作簡(jiǎn)單,療效確切,值得在TKA術(shù)后推薦應(yīng)用。
[Abstract]:Objective: to observe the effect of intermittent cold therapy on pain and swelling after artificial knee arthroplasty. Methods Sixty patients with TKAwere randomly divided into the experimental group (n = 30) and the control group (n = 30). In the experimental group, "cocktails" were injected around the joints during the operation, the epidural analgesia pump was self-controlled and the non-steroidal anti-inflammatory drugs were taken orally. The patients in the control group were not given ice bag cold therapy. The remaining treatment and functional exercise were the same as those in the treatment group. The motor pain scores of preoperative and postoperative 6 hours, 24 hours, 48 hours and 72 hours after operation were recorded respectively, and before knee joint operation, the scores of motor pain were recorded. The range of motion ROM was measured at 1 day, 2 days and 3 days after operation. The total amount of all blood drainage fluid was 24 hours and 48 hours after operation. The postoperative complications and patients' satisfaction were observed. Results: the changes of VAS at different time points before and after operation were analyzed and compared between the two groups. The difference between the two groups was statistically significant (P 0.05), which indicated that the choice of analgesic scheme was effective and could reduce the postoperative pain score of TKA. The experimental group compared with the control group, but the cold treatment group pain improvement is more obvious, the two comparison has statistical significance, which shows that cold therapy in analgesic effect is significant. The difference between the two groups at different time points after operation was statistically significant (P 0.05), which indicated that the early analgesia effect was significant, the joint got effective functional exercise early, and the range of knee joint movement was enlarged. The knee in the experimental group was better than that in the control group, and there was a significant difference between the two groups (P 0.05), which indicated that intermittent cold therapy could improve the early motion of the knee joint. According to the analysis of the drainage flow at 6 hours and 24 hours after operation, the two groups were better than the control group, and the two groups had statistical significance (P 0.05). The side effects of the two groups were analyzed, and there were no related complications in the trial group. The satisfaction rate of the two groups was 93.33 and 83.33, respectively. The difference was statistically significant, which indicated that intermittent cold therapy could improve the satisfaction of the patients. Conclusion: intermittent cold therapy can effectively improve the degree of pain, swelling, joint motion, low adverse reaction, high clinical satisfaction, low cost, simple operation and accurate curative effect after total knee arthroplasty. It is recommended to be used after TKA.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.4
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本文編號(hào)：1930827