全膝关节置换术后多模式镇痛方案的临床研究  

Multimodal Analgesia Methods for Postoperative Pain Management after Total Knee Arthroplasty

作　　者：李传翔[1] 宋伏虎[1] 王怡[1] 金大地[1] 陈力[1] 宋冬梅[1] 

机构地区：[1]南方医科大学第三附属医院麻醉科,广州510630

出　　处：《华中科技大学学报（医学版）》2010年第6期793-796,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)术后镇痛的最佳方案。方法首次行TKA患者80例,随机分成4组(n=20):对照组(C组)、帕瑞昔布组(P组)、曲马多组(T组)和芬太尼组(F组)。各组术前行术侧股神经置管,从术后1 h开始,每隔6 h(至术后48 h),由导管注入0.2%罗哌卡因15 mL。C组:当视觉模拟评分(VAS评分)>5时,静脉给予生理盐水2 mL,随后视疼痛情况每隔6 h可再静注生理盐水2 mL。P组:当VAS评分>5时,静脉给予帕瑞昔布40 mg,随后视疼痛情况每隔6 h可再静注帕瑞昔布20 mg,每天总剂量不超过80 mg。T组:当VAS评分>5时,静脉给予帕瑞昔布40 mg,10 min后若VAS评分仍大于5,静脉给予曲马多50 mg,随后视疼痛情况每隔6 h可再静注曲马多50 mg。F组:当VAS评分>5时,静脉给予帕瑞昔布40 mg,10 min后若VAS评分仍大于5,静脉给予曲马多50 mg;15 min后若VAS评分仍大于5,静脉给予芬太尼30μg;随后视疼痛情况每隔6 h可再静注芬太尼50μg。术后每8 h记录VAS评分和镇静评分;术后48 h记录不良反应的发生率并进行患者满意度调查。结果术后各时点的VAS评分,C组显著高于P组、T组和F组(均P<0.05),P组高于T组和F组(均P<0.05),而T组与F组之间差异无统计学意义(P>0.05)。术后48 h内过度镇静、恶心、呕吐的发生率,F组显著高于C组、P组和T组(均P<0.05)。患者满意度调查,T组显著高于C组、P组和F组(均P<0.05)。结论连续股神经阻滞与阶梯镇痛(帕瑞昔布和曲马多)相结合是TKA术后镇痛的一种理想方案。Objective To find an optimal method for postoperative pain management after total knee arthroplasty（TKA）.Methods Eighty patients subject to unilateral TKA were randomly divided into 4 groups（n=20 each）：control group（C group）,parecoxib group（P group）,tramadol group（T group）,fentanyl group（F group）.All the patients were infused with 15 mL of 0.2% ropivacaine via femoral nerve catheter at the first h after surgery and from then on per 6 h postoperatively till 48 h postoperatively.If the visual analogue score（VAS）5 the supplements（parecoxib,tramadol,fentanyl）would be infused in turn till the patient felt comfortable or the analgesic effect reached the clinical maximum.The VAS and sedation score（SS）were recorded per 8 h after surgery.Side effects and degree of satisfaction were investigated at the 48th h after surgery.Results In C group VAS was significantly higher than in P,T,F groups（P0.05）and that in P group was significantly higher than in T,F groups（P0.05）.There was no significant difference in VAS between T and F groups（P0.05）.The incidence of side effects was significantly higher in F group than in C,P,T groups（P0.05）and the T group had a significantly higher degree of satisfaction than in C,P,F groups（P0.05）.Conclusion Continuous femoral nerve block compound with parecoxib and tramadol is the optimal method for postoperative pain management after TKA.

关 键 词：全膝关节置换术 镇痛 神经传导阻滞 阶梯止痛 

分 类 号：R687.4[医药卫生—骨科学]