【摘要】：目的對(duì)比研究超前鎮(zhèn)痛及不同給藥時(shí)間在膝關(guān)節(jié)置換鎮(zhèn)痛方面的臨床療效。方法隨機(jī)選取2015年1月至2015年12月在我院行單側(cè)TKA的患者90例。隨機(jī)分成3組:A組術(shù)前3d口服塞來(lái)昔布,1次/12 h,200 mg/次,術(shù)中雞尾酒局部關(guān)節(jié)腔注射,術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵3d、術(shù)后6h口服塞來(lái)昔布200 mg,此后1次/12 h,200 mg/次,連續(xù)7 d。B組術(shù)前6h口服塞來(lái)昔布200 mg,術(shù)中雞尾酒局部關(guān)節(jié)腔注射,術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵3d、術(shù)后6h口服塞來(lái)昔布200 mg,此后1次/12 h,200 mg/次,連續(xù)7 d。C組術(shù)中雞尾酒局部關(guān)節(jié)腔注射,術(shù)后應(yīng)用靜脈自控鎮(zhèn)痛泵3d、術(shù)后6h口服塞來(lái)昔布200 mg,此后1次/12 h,200 mg/次,連續(xù)7 d。記錄患者術(shù)后6h、12h、1d、2d、3d靜息狀態(tài)下疼痛視覺(jué)模擬評(píng)分(visual analogue score,VAS),記錄術(shù)后1d、2d、3d、5d、7d患者活動(dòng)狀態(tài)下VAS評(píng)分,并登記術(shù)后1d、2d、3d、5d、7d膝關(guān)節(jié)活動(dòng)度,追加鹽酸哌替啶次數(shù)及鎮(zhèn)痛相關(guān)不良反應(yīng)發(fā)生情況。用SPSS 17.0行統(tǒng)計(jì)學(xué)分析,計(jì)量資料用t檢驗(yàn),計(jì)數(shù)資料用X2檢驗(yàn),P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果(1)患者術(shù)后6h、12h、1d、2d、3d靜息狀態(tài)下膝關(guān)節(jié)VAS評(píng)分B組和C組大于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義;B組大于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義,(2)術(shù)后1d、2d、3d、5d、7d患者活動(dòng)狀態(tài)下膝關(guān)節(jié)VAS評(píng)分B組和C組大于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義;B組大于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義,(3)術(shù)后1d、2d、3d、5d、7d膝關(guān)節(jié)活動(dòng)度:B組和C組低于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義;B組低于A組,P0.05,具有統(tǒng)計(jì)學(xué)意義,(4).各組鎮(zhèn)痛相關(guān)不良反應(yīng)發(fā)生情況:三組之間無(wú)明顯差異,P0.05,無(wú)統(tǒng)計(jì)學(xué)意義;A組追加鹽酸哌替啶的次數(shù)明顯低于B組及C組,P0.05,具有統(tǒng)計(jì)學(xué)意義。結(jié)論通過(guò)對(duì)比研究超前鎮(zhèn)痛及不同給藥時(shí)間在膝關(guān)節(jié)置換鎮(zhèn)痛方面的臨床療效。發(fā)現(xiàn)術(shù)前口服塞來(lái)昔布超前鎮(zhèn)痛聯(lián)合多模式鎮(zhèn)痛組具有良好的鎮(zhèn)痛效果,對(duì)早期膝關(guān)節(jié)功能恢復(fù)有明顯優(yōu)勢(shì),沒(méi)有增加并發(fā)癥,并且發(fā)現(xiàn)超前鎮(zhèn)痛術(shù)前不同給藥時(shí)間其鎮(zhèn)痛效果不同。
[Abstract]:Objective to compare the clinical efficacy of preemptive analgesia and different administration time in knee arthroplasty analgesia. Methods from January 2015 to December 2015, 90 patients with unilateral TKA were randomly selected. Group A was randomly divided into three groups: group A was given celecoxib 3 days before operation, once a 12 hours, 200 mg/ times, intraoperative cocktail local joint cavity injection, postoperative intravenous automatic analgesia pump 3 days, celecoxib 200 mg, once a 12 hours after operation, 200 mg/ times, 7 D.B group 6 hours before operation, celecoxib 200 mg, intraoperative cocktail local joint cavity injection, postoperative use of intravenous self-controlled analgesia pump 3 days after operation, the patients in group A were treated with celecoxib 200 mg, intraoperative joint cavity injection for 6 hours before operation, and the patients in group A were treated with celecoxib 200 mg, intraoperative joint cavity injection for 3 days after operation. At 6 h after operation, celecoxib 200 mg, was taken once / 12 h, 200 mg/ times, 7 d. C group intraoperative cocktail local joint cavity injection, 3 d postoperative intravenous automatic analgesia pump, 6 h after operation, celecoxib 200 mg, was taken once a 12 h, 200 mg/ times for 7 d. The visual analog score of pain was recorded at 6 h, 12 h, 2 d, 3 d, 5 d, 7 d after operation, and the VAS score was recorded on the 1st day, 2nd day, 5th day, 7th day and 7th day after operation. SPSS 17.0 was used for statistical analysis, t test for measurement data, X2 test for counting data, and P 0.05 for statistical difference. Results (1) the VAS score of knee joint in group B and C was significantly higher than that in group A, P0.05, group B was larger than group A, P0.05, and group B was larger than group A, P0.05, respectively. (2) on the 1st day, 3rd day, 5th day, the VAS score of knee joint in group B and group C was higher than that in group A, P0.05, with statistical significance. Group B was larger than group A, P0.05, with statistical significance. (3) on the 1st day, 2nd day, 5th day and 7th day after operation, the range of knee motion in group B and C was lower than that in group A, P0.05, and that in group B was lower than that in group A, P0.05, with statistical significance, (4). The incidence of adverse reactions related to analgesia in each group: there was no significant difference among the three groups, P0.05, but the frequency of pethidine hydrochloric acid in group A was significantly lower than that in group B and C, P0.05, with statistical significance. Conclusion the clinical efficacy of preemptive analgesia and different administration time in knee arthroplasty analgesia was studied by comparing the clinical efficacy of preemptive analgesia and different administration time. It was found that oral celecoxib preemptive analgesia combined with multimode analgesia group had good analgesic effect, had obvious advantages in early knee joint function recovery, and did not increase complications. It was found that the analgesic effect was different at different time before preoperation.
【學(xué)位授予單位】：青島大學(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)：2506345