關(guān)節(jié)內(nèi)注射雞尾酒式鎮(zhèn)痛復(fù)合液的近期及遠(yuǎn)期效果
發(fā)布時(shí)間：2018-08-12 20:30
【摘要】：目的:評(píng)估全膝關(guān)節(jié)置換術(shù)后關(guān)節(jié)內(nèi)注射雞尾酒式鎮(zhèn)痛復(fù)合液鎮(zhèn)痛的近期及遠(yuǎn)期效果。方法:由相同的醫(yī)師組手術(shù)治療的的單側(cè)TKA骨性關(guān)節(jié)炎(OA)患者40例(40膝),并隨機(jī)分成兩組(A組和B組),分別為20人,A組中有男性患者3名,女性患者17名,年齡54-76歲,平均(62.75±5.80)歲;B組中有男性患者2名,女性患者18名,年齡51-67歲,平均(59.95±1.04)歲。A組術(shù)中采取“雞尾酒”方案,即:羅哌卡因注射液150 mg、舒芬太尼注射液10ug,加生理鹽水至100 ml,對(duì)關(guān)節(jié)周?chē)浗M織(包含關(guān)節(jié)囊、韌帶和皮下組織)進(jìn)行注射。整個(gè)過(guò)程分為三步。首先,截骨后于關(guān)節(jié)后方關(guān)節(jié)囊注射約40ml,注射前輕輕回抽以防止注入乆窩血管。然后,安裝假體后在骨水泥固化前,于內(nèi)外側(cè)副韌帶、前方關(guān)節(jié)囊、骨膜、股四頭肌腱、關(guān)節(jié)囊切口及髕下韌帶注射30ml,最后關(guān)閉切口及松止血帶前在切口周?chē)?皮下組織)注射30ml。B組:術(shù)中只給予生理鹽水100 ml,不包括羅哌卡因及舒芬太尼,與A組患者操作一致,對(duì)關(guān)節(jié)周?chē)浗M織(包含關(guān)節(jié)囊、韌帶和皮下組織)進(jìn)行注射。若患者術(shù)后自覺(jué)疼痛無(wú)法忍受,可給患者100 mg鹽酸曲馬多肌注。比較兩組患者術(shù)后48小時(shí)內(nèi)的患者鎮(zhèn)痛藥物追加次數(shù)、一般情況及不良反應(yīng)發(fā)生情況,術(shù)后48小時(shí)內(nèi)及術(shù)后1年時(shí)膝關(guān)節(jié)視覺(jué)模擬疼痛評(píng)分。VAS評(píng)分的操作是采用一條約10cm長(zhǎng)的尺子,一個(gè)面刻有10個(gè)刻度,兩端各自表示為0分和10分,0分代表了無(wú)痛,10分代表了難以忍受的劇痛,中間部分代表了不同程度的疼痛,測(cè)試時(shí)患者面對(duì)著無(wú)刻度的一面,讓其在標(biāo)尺上指出能代表自己此時(shí)疼痛程度的相應(yīng)的位置。同時(shí)操作者面對(duì)有刻度的一面,然后再根據(jù)患者標(biāo)出的位置得到相應(yīng)的分值。隨訪時(shí)的活動(dòng)VAS評(píng)分通過(guò)爬樓梯測(cè)試來(lái)完成,具體操作如下:讓隨訪患者爬上10階樓梯(每階大概15cm高),然后再回到原點(diǎn)。其中慢性疼痛定義為術(shù)后1年時(shí)在爬樓梯試驗(yàn)中VAS評(píng)分大于等于4的疼痛。結(jié)果:1兩組患者在年齡、性別比例、體重及手術(shù)時(shí)間等方面均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2術(shù)后48小時(shí)內(nèi)VAS評(píng)分A組患者靜息時(shí)的VAS評(píng)分在4h、8h、16h、24h、48h時(shí)分別為3.27±0.39,3.46±0.41,4.08±0.31,3.47±0.42,3.33±0.36,活動(dòng)時(shí)的VAS評(píng)分在4h、8h、16h、24h、48h時(shí)分別為4.14±0.46,4.80±0.44,5.17±0.44,4.62±0.36,4.32±0.30;B組患者靜息時(shí)的VAS評(píng)分在4h、8h、16h、24h、48h時(shí)分別為3.38±0.40,4.05±0.29,4.65±0.40,4.48±0.32,3.29±0.37,活動(dòng)時(shí)的VAS評(píng)分在4h、8h、16h、24h、48h時(shí)分別為4.85±0.38,5.35±0.30,5.74±0.34,5.41±0.36,4.40±0.31。A組患者活動(dòng)時(shí)的VAS評(píng)分在術(shù)后4h、8h、16h、24h均低于B組,具有統(tǒng)計(jì)學(xué)差異(P0.05),術(shù)后48h后兩組患者的VAS評(píng)分無(wú)顯著性差異(P0.05);兩組患者靜息時(shí)的VAS評(píng)分在術(shù)后4h內(nèi)的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而A組患者術(shù)后8h、16h、24h的VAS評(píng)分均較B組患者低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后48h后兩組患者的VAS評(píng)分無(wú)顯著性差異(P0.05)。3術(shù)后鎮(zhèn)痛藥物追加次數(shù)兩組患者術(shù)后鹽酸曲馬多在各個(gè)時(shí)間段的追加次數(shù)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。4術(shù)后一般情況兩組患者在心率、血氧飽和度及平均動(dòng)脈壓等生命體征上,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5不良反應(yīng)發(fā)生率A組與B組比較,兩組患者術(shù)后的惡心、嘔吐、皮膚瘙癢以及呼吸抑制等不良反應(yīng)的發(fā)生率差異無(wú)顯著性(P0.05)。6術(shù)后1年隨訪情況兩組患者靜息時(shí)的VAS評(píng)分分別為0.89±0.25和1.06±0.34,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);活動(dòng)時(shí)的VAS評(píng)分分別為2.81±0.47和3.22±0.68,A組患者VAS評(píng)分較B組患者低,具有統(tǒng)計(jì)學(xué)意義(P0.05)。A組患者慢性疼痛發(fā)生率為5.0%(1/20),B組為30.0%(6/20),B組患者慢性疼痛發(fā)生率明顯高于A組,具有統(tǒng)計(jì)學(xué)差異(P0.05),尚不能排除B組慢性疼痛的發(fā)生率是A組慢性疼痛發(fā)生率的6倍。結(jié)論:關(guān)節(jié)腔內(nèi)注射雞尾酒鎮(zhèn)痛可以有效緩解術(shù)后急性疼痛,促進(jìn)早期功能恢復(fù),并且在預(yù)防患者的慢性疼痛方面起到了重要作用,是全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的良好選擇。
[Abstract]:Objective: To evaluate the short-term and long-term effects of intra-articular injection of cocktail analgesic compound solution after total knee arthroplasty (TKA). Methods: 40 patients (40 knees) with unilateral TKA osteoarthritis (OA) were divided into two groups (group A and group B) randomly. There were 20 patients in group A, 3 males and 17 females. The age ranged from 54 to 76 years, with an average age of (62.75 (+ 5.80) years. In group B, there were 2 males and 18 females, aged 51 to 67 years, with an average age of (59.95 (+ 1.04) years. Tissue) Injection. The whole process is divided into three steps. First, about 40 ml is injected into the posterior articular capsule after osteotomy, then gently withdrawn before injection to prevent injection into the fovea. Then, 30 ml is injected into the medial and lateral collateral ligaments, anterior capsule, periosteum, quadriceps tendon, capsule incision and Subpatellar ligament before cementation. Inject 30 ml of saline around the incision (subcutaneous tissue) before closing the incision and loosening the tourniquet. In group B, only 100 ml of normal saline, excluding ropivacaine and sufentanil, was administered intraoperatively. The soft tissues around the joint (including the joint capsule, ligaments and subcutaneous tissue) were injected as in group A. If the patient felt that the pain could not be tolerated after the operation, the saline was administered. Patients received 100 mg tramadol hydrochloride intramuscular injection. The number of additional analgesic drugs, general conditions and adverse reactions were compared between the two groups within 48 hours after operation. Visual analogue pain score of knee joint was obtained within 48 hours after operation and 1 year after operation. VAS was performed by using a ruler about 10 cm long with 10 scales on one side and 10 scales on both ends. Self-reported 0 and 10 points, 0 points for pain, 10 points for unbearable pain, the middle part represents varying degrees of pain, the test patients face the scale, let them point out on the scale can represent the degree of pain at this time the corresponding position. The active VAS score at follow-up was achieved by stair climbing test. The following procedure was performed: follow-up patients climbed 10 stairs (about 15 cm high each) and then returned to the original point. Chronic pain was defined as pain with a VAS score greater than or equal to 4 in stair climbing test at 1 year after surgery. There was no significant difference in age, sex ratio, body weight and operation time between the two groups (P 0.05). VAS score at rest in group A was 3.27 [0.39], 3.46 [0.41], 4.08 [0.31], 3.47 [0.42], 3.33 [0.36], and VAS score at activity was 4 h, 8 h, 16 h, 24 h, 48 h, respectively. 46,4.46,4.80 [0.44,4.80 [0.44,5.17 [0.44,0.44,5.17 [0.44,4.62 [0.36,4.32 [0.36,4.32 [0.36,4.32 [0.30.38 [0.40,0.40,4.05 [0.29,4.29,4.65 [0.65 [0.40,40.40.40,4.48 [.48 [0.32,4.48 [0.32,3.29 [0.37,VAS at 4.85 [0.38,0.38,5.35.35.38,35.35.30,35.35.35.30,35.35.VAS during activity in group A The VAS scores in group A were lower than those in group B at 4, 8, 16 and 24 hours after operation (P 0.05). There was no significant difference in VAS scores between the two groups 48 hours after operation (P 0.05). There was no significant difference in resting VAS scores between the two groups within 4 hours after operation (P 0.05). The VAS scores in group A were lower than those in group B at 8, 16 and 24 hours after operation (P 0.05). Significance (P 0.05). There was no significant difference in VAS score between the two groups 48 hours after operation (P 0.05). 3 There was no significant difference in the number of postoperative tramadol hydrochloride addition between the two groups (P 0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, pruritus and respiratory depression between group A and group B (P 0.05). The VAS scores at rest were 0.89 (+ 0.25) and 1.06 (+ 0.34) at 1 year follow-up, respectively, with no significant difference between the two groups (P 0.05). The VAS score of group A was lower than that of group B (P 0.05). The incidence of chronic pain in group A was 5.0% (1/20), and that in group B was 30.0% (6/20). The incidence of chronic pain in group B was significantly higher than that in group A (P 0.05). The incidence of chronic pain in group A was significantly higher than that in group B (P 0.05). Conclusion: Intra-articular injection of cocktail analgesia can effectively relieve postoperative acute pain, promote early functional recovery, and play an important role in preventing chronic pain in patients with total knee arthroplasty, which is a good choice for postoperative analgesia.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.4
[Abstract]:Objective: To evaluate the short-term and long-term effects of intra-articular injection of cocktail analgesic compound solution after total knee arthroplasty (TKA). Methods: 40 patients (40 knees) with unilateral TKA osteoarthritis (OA) were divided into two groups (group A and group B) randomly. There were 20 patients in group A, 3 males and 17 females. The age ranged from 54 to 76 years, with an average age of (62.75 (+ 5.80) years. In group B, there were 2 males and 18 females, aged 51 to 67 years, with an average age of (59.95 (+ 1.04) years. Tissue) Injection. The whole process is divided into three steps. First, about 40 ml is injected into the posterior articular capsule after osteotomy, then gently withdrawn before injection to prevent injection into the fovea. Then, 30 ml is injected into the medial and lateral collateral ligaments, anterior capsule, periosteum, quadriceps tendon, capsule incision and Subpatellar ligament before cementation. Inject 30 ml of saline around the incision (subcutaneous tissue) before closing the incision and loosening the tourniquet. In group B, only 100 ml of normal saline, excluding ropivacaine and sufentanil, was administered intraoperatively. The soft tissues around the joint (including the joint capsule, ligaments and subcutaneous tissue) were injected as in group A. If the patient felt that the pain could not be tolerated after the operation, the saline was administered. Patients received 100 mg tramadol hydrochloride intramuscular injection. The number of additional analgesic drugs, general conditions and adverse reactions were compared between the two groups within 48 hours after operation. Visual analogue pain score of knee joint was obtained within 48 hours after operation and 1 year after operation. VAS was performed by using a ruler about 10 cm long with 10 scales on one side and 10 scales on both ends. Self-reported 0 and 10 points, 0 points for pain, 10 points for unbearable pain, the middle part represents varying degrees of pain, the test patients face the scale, let them point out on the scale can represent the degree of pain at this time the corresponding position. The active VAS score at follow-up was achieved by stair climbing test. The following procedure was performed: follow-up patients climbed 10 stairs (about 15 cm high each) and then returned to the original point. Chronic pain was defined as pain with a VAS score greater than or equal to 4 in stair climbing test at 1 year after surgery. There was no significant difference in age, sex ratio, body weight and operation time between the two groups (P 0.05). VAS score at rest in group A was 3.27 [0.39], 3.46 [0.41], 4.08 [0.31], 3.47 [0.42], 3.33 [0.36], and VAS score at activity was 4 h, 8 h, 16 h, 24 h, 48 h, respectively. 46,4.46,4.80 [0.44,4.80 [0.44,5.17 [0.44,0.44,5.17 [0.44,4.62 [0.36,4.32 [0.36,4.32 [0.36,4.32 [0.30.38 [0.40,0.40,4.05 [0.29,4.29,4.65 [0.65 [0.40,40.40.40,4.48 [.48 [0.32,4.48 [0.32,3.29 [0.37,VAS at 4.85 [0.38,0.38,5.35.35.38,35.35.30,35.35.35.30,35.35.VAS during activity in group A The VAS scores in group A were lower than those in group B at 4, 8, 16 and 24 hours after operation (P 0.05). There was no significant difference in VAS scores between the two groups 48 hours after operation (P 0.05). There was no significant difference in resting VAS scores between the two groups within 4 hours after operation (P 0.05). The VAS scores in group A were lower than those in group B at 8, 16 and 24 hours after operation (P 0.05). Significance (P 0.05). There was no significant difference in VAS score between the two groups 48 hours after operation (P 0.05). 3 There was no significant difference in the number of postoperative tramadol hydrochloride addition between the two groups (P 0.05). There was no significant difference in the incidence of postoperative nausea, vomiting, pruritus and respiratory depression between group A and group B (P 0.05). The VAS scores at rest were 0.89 (+ 0.25) and 1.06 (+ 0.34) at 1 year follow-up, respectively, with no significant difference between the two groups (P 0.05). The VAS score of group A was lower than that of group B (P 0.05). The incidence of chronic pain in group A was 5.0% (1/20), and that in group B was 30.0% (6/20). The incidence of chronic pain in group B was significantly higher than that in group A (P 0.05). The incidence of chronic pain in group A was significantly higher than that in group B (P 0.05). Conclusion: Intra-articular injection of cocktail analgesia can effectively relieve postoperative acute pain, promote early functional recovery, and play an important role in preventing chronic pain in patients with total knee arthroplasty, which is a good choice for postoperative analgesia.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 林憲軍;王棟;;中西醫(yī)結(jié)合治療膝關(guān)節(jié)痛臨床觀察[J];中醫(yī)學(xué)報(bào);2011年08期
2 賈東林;李水清;韓彬;王軍;郭向陽(yáng);余家闊;;刺激型導(dǎo)管連續(xù)股神經(jīng)阻滯術(shù)后鎮(zhèn)痛效果觀察[J];臨床麻醉學(xué)雜志;2011年03期
3 秦維龍;孟慶才;方銳;鄧迎杰;孫海威;王榮;;中醫(yī)藥鎮(zhèn)痛方案在人工膝關(guān)節(jié)置換術(shù)圍手術(shù)期的療效觀察[J];中醫(yī)藥導(dǎo)報(bào);2010年10期
4 王懷江;張大志;李世忠;;2種鎮(zhèn)痛方法在全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛效果的比較[J];中日友好醫(yī)院學(xué)報(bào);2010年03期
5 吳林飛;徐旭仲;董小秋;夏宇宙;;超前鎮(zhèn)痛對(duì)全膝關(guān)節(jié)置換術(shù)后疼痛及患者血漿P物質(zhì)和血清IL-6的影響[J];蘇州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2010年03期
6 宋先榮;艾艷秋;;術(shù)后鎮(zhèn)痛研究的進(jìn)展[J];醫(yī)學(xué)綜述;2009年05期
7 張俊;蔣W，
本文編號(hào)：2180281
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2180281.html
最近更新
教材專(zhuān)著
