人工全髋关节置换术中运用多模式镇痛的疗效评价  

Evaluation of multimodal analgesia on patients with total hiparthroplasty

作　　者：董文君[1] 董芳辉[1] 胡三莲[1] 钱会娟[1] 

机构地区：[1]上海交通大学附属第六人民医院,上海200233

出　　处：《新医学》2013年第6期396-399,共4页Journal of New Medicine

摘　　要：目的研究多模式镇痛对人工全髋关节置换术患者功能锻炼的镇痛效果。方法选择拟行人工全髋关节置换术的患者105例,随机分为观察(A、B)组和对照组,3组例数分别为35、36、34例。观察A组患者术前给予"多模式镇痛"理念的宣教,术中接受静脉注射用帕瑞昔布钠40mg和关节腔周围注射盐酸罗哌卡因注射液100 mg;观察B组患者术前给予"多模式镇痛"理念的宣教,术中接受关节腔周围鸡尾酒样注射帕瑞昔布钠40 mg以及关节周围注射盐酸罗哌卡因注射液100mg。观察A、B组术后均给予注射用帕瑞昔布钠、盐酸曲马多缓释片、塞来昔布(西乐葆),并予指导行功能锻炼。对照组术中行关节周围注射盐酸罗哌卡因注射液100 mg和术后使用静脉自控式镇痛泵48 h、盐酸曲马多缓释片、塞来昔布,并予指导行功能锻炼,比较各组镇痛疗效。结果观察组的静息疼痛VAS评分与对照组比较差异有统计学意义(P<0.05)。观察A组与B组相比,比较差异无统计学意义(P>0.05)。3组不良反应比较差异无统计学意义(P>0.05)。观察A、B组康复不依从率较对照组低,但比较差异未达统计学意义(P=0.058)。结论在人工全髋关节置换术中运用多模式镇痛,术后镇痛效果良好,不良反应少。Objective To study the effect of multimodal analgesia on postoperative physical exercises in patients with total hiparthroplasty. Methods One hundred and five patients with total hip arthroplasty were selected from March 2010 to June 2010 for the study. They were randomly divided into three groups, observa-tion group （ group A and group B） and control group. All patients received the treatments of periarticular in-jection of ropivaeaine hydrochlorid. Patients controlled group received a postoperative epidural analgesia, with administration of tramcontin and celecoxib. The patients in group A received education of muhimodal pain con- trol protocol and intravenous injection of parecoxib, and patients in group B received education of multimodal pain control protocol and intraoperative injection around the joint cavity. The VAS score, functional exercises （range of motion, straight leg raising, postoperative walking） and compliance for patients among the three groups were observed and compared. Results There were significant difference of resting pain VAS score, postoperative limbs situation （range of motion, straight leg raisin, postoperative ambulation） and compliance between observation and control group. But no remarkable differences were observed between group A and group B. Conclusions Multimodal pain control protocol after total hip arthroplasty can significantly reduce the pain after replacement and promote the recovery of hip function, increase the compliance of patients with post-operative functional exercise.

关 键 词：多模式镇痛 人工全髋关节置换术 功能锻炼 效果观察 

分 类 号：R614[医药卫生—麻醉学]