联合多模式镇痛在全髋关节置换术后的早期疗效  

Early effects of multi-modal analgesia method after total hip replacement

作　　者：张飞[1] 李奇[2] 林荔军[2] 刘成龙[2] 

机构地区：[1]赣南医学院第一附属医院骨科,341000 [2]南方医科大学珠江医院骨科中心,广州510280

出　　处：《中华关节外科杂志（电子版）》2013年第3期33-35,共3页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的评估联合多模式镇痛技术在全髋关节置换(THR)术后的早期疗效。方法本组自2011年6月至2012年5月共收治了97例(104髋)接受THR的患者,男43例,女54例,平均年龄(56.14±2.97)岁。术后采用联合多模式镇痛技术进行围手术镇痛,除给予术后常规药物镇痛外,所有患者均接受了如术前宣教、超前镇痛、物理疗法以及术后肢体功能锻炼等综合措施。由同一术者实施,关节假体及器械均选自同一厂家,自术后12h随机将上述104髋分为两组进行比较,实验组联合应用及通安片与非甾体类镇痛药物,对照组单纯服用非甾体类镇痛药进行镇痛,术后指导患者行肢体功能锻炼,以患者主观疼痛及关节活动情况作为主要观察指标,以数字疼痛评分法(NPRS)对静息痛与关节活动后疼痛评分进行量化评估镇痛效果。结果实验组静息痛与关节活动后疼痛总体NPRS评分分别为(4.74±0.77)及(6.14±1.41)分,对照组则分别为(5.11±1.01)及(7.23±0.97)分,经SPSS13.0软件包统计学检验,两组间有统计学差异。出院时实验组与对照组关节主动活动能力比较有统计学差异。结论联合多模式镇痛在THR术后的早期疗效较好,利于关节功能恢复,是一种较廉价的镇痛模式。Objective To evaluate the early effects on the patients after total hip replacement with a multi-modal analgesia method. Methods Total hip replacement was performed on 97 patients （ 104 hips） between June 2011 and May 2012. The numbers of male and female were 43 and 54 respectively. The mean age was （56. 14 ± 2. 97 ） years. A multi-modal analgesia method was applied for perioperative analgesia. In addition to the conventional analgesic drugs, comprehensive measures including preoperative education, pre-emptive analgesia, physical therapy and postoperative limb functional exercise were carried out in all patients. The operations were performed by the same surgeon. The prostheses and instruments were provided by the same company. The 104 hips were randomly divided into two groups 12 hours after operation, as the experimental group and the control group. Paracetamol and Tramadol hydrochloride tablets combined with NSAID drugs were prescribed to the experimental group, while NSAID drugs were the only prescription applied to the control group. The subjective sense of pain and joint activities were observed as major indicators. Numerical pain rating scale （NPRS） was applied to evaluate the rest pain and the active pain, so that the analgesia effects were assessed. Results In the experimental group, the total NPRS score of the rest pain was （4.74 ±0. 77） and the score of the active pain was （6. 14 ± 1.41 ） , while the scores in the control group were （5. 11 ± 1.01 ） and （7. 23 ± 0. 97） respectively. There were statistically significant differences between the two groups after t-test analysis with SPSS 13.0 software. Joint initiative activities comparison of the two groups also showed statistically significant difference when patients were discharged. Conclusions The multi-modal analgesia method has a good effect on the early outcome after THR, which is considered as an inexpensive model to restore hip function.

关 键 词：镇痛 关节成形术 置换髋 

分 类 号：R614[医药卫生—麻醉学]