伴有心脏疾患病人全膝关节置换术中关节周围大剂量布比卡因注射镇痛的疗效和安全性  

Effect and safety of periarticular high-dose bupivacaine injections during total knee arthroplasy in patients with heart diseases

作　　者：何川[1,2] 冯建民[1] 刘志宏[1,2] 王毅[1,2] 杨庆铭[1,2] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,200025 [2]上海交通大学医学院附属瑞金医院上海市伤骨科研究所,200025

出　　处：《中国矫形外科杂志》2011年第16期1321-1324,共4页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81071473)

摘　　要：[目的]研究人工全膝关节置换术(TKA)中关节周围软组织注射含有大剂量布比卡因的混合药物进行术后镇痛对于伴有心脏疾患病人的临床疗效以及有无毒副反应。[方法]35例准备进行单侧TKA的骨关节炎病人根据是否伴发心脏疾患分为心脏病组(12例)和非心脏病组(23例)。在围手术期所有患者按相同镇痛方案治疗,术中关节周围注射"Ranawat Cocktail"镇痛药液(包含0.75%布比卡因250 mg,吗啡4 mg,肾上腺素0.3 mg,甲基强的松龙40 mg,头孢唑啉0.5 g,生理盐水57 ml)。记录患者术后疼痛VAS评分、满意度、膝关节活动度、主动直腿抬高时间、伤口并发症、术后住院天数、心电图异常及心血管并发症等。[结果]两组病人术后VAS评分、满意度、膝关节活动度、主动直腿抬高时间和术后住院天数均无统计学差异,所有病人无伤口并发症以及心血管并发症发生。[结论]在TKA术中,关节周围注射含有大剂量布比卡因的"Ranawat Cocktail"混合药物对伴发心脏疾患的病人同样可以提供很好的术后镇痛效果,并且具有良好的安全性。[Objective]To investigate postoperative early efficacy of periarticular injections consisting of high-dose bupinvacaine in patients with heart disease to provide analgesia following total knee arthroplasty（TKA）.[Method]In 35 consecutive patients with osteoarthritis scheduled to undergo unilateral TKAs,12 patients with heart disease were assigned to heart disease group and the others to the no-heart disease group.They were treated with some perioperative multimodal analgesia protocol,receiving one intraoperative periarticular injection multimodal drug fluid ＂Ranawat Cocktail＂（consjsting of 250 mg bupivacaine,0.3 mg epinephrine,4 mg morphine sulfate,40 mg methylprednisolone,0.5 g cefarolin,37 ml normal saline）.Visual analog scores for pain at some time point up to 7 days postoperatively,total satisfaction score,the range of motion of knee joint,time of active straight leg raising,wound complications,hospital stay,electrocardiongram and complications related to cardiovascular system were recorded.[Result]No significant group differences in terms of pain,total satisfaction score,the range of motion of knee joint,time of active straight leg raising and hospital stay were identified.No wound or cardiovascular complication was found in all patients.[Conclusion]The periarticular injuection of ＂Ranawat Cocktail＂,consisting of high-dose bupivacaine,can offer excellent pain control and functional recovery to patients,even to those with heart diseases.

关 键 词：全膝置换术 关节周围注射 布比卡因 心脏病 疼痛 

分 类 号：R687.4[医药卫生—骨科学]