【摘要】：背景：人工全膝關(guān)節(jié)置換術(shù)已成為治療膝關(guān)節(jié)終末期疾病的主要治療方法。但該術(shù)式圍手術(shù)期疼痛率仍高達(dá)90%。研究表明多模式鎮(zhèn)痛及傳統(tǒng)的患者自控鎮(zhèn)痛均可有效降低人工全膝關(guān)節(jié)置換圍手術(shù)期疼痛程度,但對(duì)比多模式鎮(zhèn)痛及患者自控鎮(zhèn)痛的研究少有報(bào)道。目的：對(duì)比研究人工全膝關(guān)節(jié)置換術(shù)圍手術(shù)期多模式鎮(zhèn)痛與傳統(tǒng)的患者自控鎮(zhèn)痛的有效性和安全性。方法：選擇2013年2月至2014年3月在我科行初次單側(cè)人工全膝關(guān)節(jié)置換術(shù)的患者60例。隨機(jī)分為兩組,實(shí)驗(yàn)組為多模式鎮(zhèn)痛組(27例),術(shù)中關(guān)節(jié)腔及周圍組織“雞尾酒”鎮(zhèn)痛藥注射,術(shù)后給予阿片類藥物及非甾體類消炎鎮(zhèn)痛藥物；對(duì)照組為單一的患者自控鎮(zhèn)痛組(33例),術(shù)中未用鎮(zhèn)痛藥物,術(shù)后給于患者靜脈自控鎮(zhèn)痛。術(shù)后72小時(shí)內(nèi)每隔4小時(shí)記錄NRS評(píng)分,之后每天評(píng)估一次,取其平均值,對(duì)比術(shù)后第1周,第2周,第3周的NRS評(píng)分；訪問(wèn)并記錄對(duì)比術(shù)后第1周,第2周,第3周的患者滿意度；記錄并對(duì)比術(shù)后24小時(shí)、48小時(shí)及72小時(shí)關(guān)節(jié)功能康復(fù)鍛煉達(dá)標(biāo)；記錄并對(duì)比實(shí)驗(yàn)結(jié)束時(shí)患者鎮(zhèn)痛藥物使用總量、副作用的發(fā)生率。組間計(jì)量資料比較采用獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),等級(jí)資料采用秩和檢驗(yàn)。將P0.05視為有顯著統(tǒng)計(jì)學(xué)意義。結(jié)果：(1)多模式鎮(zhèn)痛組術(shù)后各個(gè)時(shí)間點(diǎn)NRS疼痛評(píng)顯著低于傳統(tǒng)的患者自控鎮(zhèn)痛組,差異有顯著性(p0.05)；(2)多模式鎮(zhèn)痛組術(shù)后第1周,第2周,第3周患者滿意度均高于傳統(tǒng)的患者自控鎮(zhèn)痛組,差異有顯著性(p0.05)；(3)術(shù)后3周,多模式鎮(zhèn)痛組鎮(zhèn)痛藥物使用量及副作用發(fā)生率均顯著少于傳統(tǒng)的患者自控鎮(zhèn)痛組(p0.01)；(4)多模式鎮(zhèn)痛組術(shù)后24小時(shí)關(guān)節(jié)功能康復(fù)鍛煉達(dá)標(biāo)率顯著高于傳統(tǒng)的患者自控鎮(zhèn)痛組(p0.01)。結(jié)論：初次單側(cè)人工全膝關(guān)節(jié)置換術(shù)圍手術(shù)期采用多模式鎮(zhèn)痛較傳統(tǒng)的患者自控鎮(zhèn)痛在減少鎮(zhèn)痛藥使用量的同時(shí),可顯著降低患者的疼痛程度及鎮(zhèn)痛藥副作用的發(fā)生率,并可顯著加快患者術(shù)后的膝關(guān)節(jié)功能康復(fù)。
[Abstract]:Background: total knee arthroplasty has become the main treatment for end-stage knee disease. However, the perioperative pain rate is still as high as 90. The study shows that both multi-mode analgesia and traditional patient-controlled analgesia can effectively reduce the degree of perioperative pain after total knee arthroplasty, but there are few reports on the comparison of multi-mode analgesia and patient-controlled analgesia. Objective: to compare the efficacy and safety of perioperative multi-mode analgesia and traditional patient-controlled analgesia in total knee arthroplasty. Methods: from February 2013 to March 2014, 60 patients underwent the first unilateral total knee arthroplasty in our department. Two groups were randomly divided into two groups: the experimental group (n = 27) was treated with multi-mode analgesia group (n = 27), the joint cavity and surrounding tissues were injected with "cocktail" analgesics during the operation, and the opioid drugs and non-steroidal anti-inflammatory analgesic drugs were given after operation. The control group was single patient controlled analgesia group (33 cases). NRS scores were recorded every 4 hours within 72 hours after operation, and then evaluated every day. The NRS scores were compared at the 1st, 2nd and 3rd week after operation. The patients' satisfaction at the first week, the second week and the third week after operation were recorded and recorded, and 24, 48 and 72 hours after operation were recorded and compared. The total amount of analgesic drugs and the incidence of side effects were recorded and compared at the end of the experiment. Independent sample t test, chi-square test and rank sum test were used to compare the metrological data among groups. The P0.05 was regarded as statistically significant. Results: (1) the NRS pain assessment in the multi-mode analgesia group was significantly lower than that in the traditional patient-controlled analgesia group (p0.05). (2) the patients' satisfaction in the first week, the second week and the third week after operation in the multi-mode analgesia group was higher than that in the traditional patient-controlled analgesia group (p0.05). (3) at 3 weeks after operation, the dosage of analgesic drugs and the incidence of side effects in the multi-mode analgesia group were significantly lower than those in the traditional patient-controlled analgesia group (p0.01). (4) 24 hours after operation, the rate of joint functional rehabilitation in multi-mode analgesia group was significantly higher than that in traditional patient-controlled analgesia group (p0.01). Conclusion: compared with traditional patient-controlled analgesia, the first unilateral total knee arthroplasty can significantly reduce the degree of pain and the incidence of side effects of analgesics compared with the traditional patient-controlled analgesia. It can accelerate the rehabilitation of knee joint function after operation.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614

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