全膝关节置换围手术期两种镇痛方案的比较  

Comparison of effects of two analgesic protocols in perioperative period of total knee arthroplasty

作　　者：王超[1] 刘明廷[1] 戚大春[1] 李贤让[1] 孟涛[1] 

机构地区：[1]滨州医学院附属医院骨关节外科,山东滨州256603

出　　处：《中国矫形外科杂志》2015年第9期789-793,共5页Orthopedic Journal of China

摘　　要：[目的]比较全膝关节置换围手术期两种镇痛方案的效果。[方法]60例全膝关节置换术患者,随机采用围手术期程序化多模式镇痛方案(PEPMA组)和术后多模式镇痛方案(POMA组)。两组患者均在5个时间点采末梢静脉血,测定标本中SP和IL-6的浓度。采用视觉模拟评分(VAS)记录疼痛程度,HSS评分评估膝关节功能。[结果]术后6、12、24 h的血浆SP含量,PEPMA组为[(103.38±8.25),(121.74±8.75),(101.61±6.13)]pg/ml,POMA组为[(112.87±6.02),(134.44±7.05),(108.91±6.47)]pg/ml,两组间差异有统计学意义(P<0.01);血清IL-6含量,PEPMA组为[(48.43±10.12),(61.84±12.53),(43.31±11.13)]pg/ml,POMA组为[(67.31±12.03),(93.24±36.51),(61.21±10.39)]pg/ml,两组间差异有统计学意义(P<0.01)。两组术后6、12、24、48 h的VAS评分PEPMA组显著低于POMA组(P<0.01);术后3 d HSS评分PEPMA组显著高于POMA组(P<0.01)。[结论]围手术期程序化多模式镇痛能够更好地降低患者血浆SP及血清IL-6的水平,减轻全膝关节置换围术期疼痛,促进膝关节功能早期恢复。[Objective] To compare effects of two approaches to pain management in the perioperative period of total knee arthroplasty. [Methods] Sixty patients with end- stage osteoarthritis who were undergoing total knee arthroplasty,were randomly divided into two groups,the perioperative procedural multimodal analgesia（ PEPMA） group and the postoperative multimodal analgesia group（ POMA）. Two groups of patients were collected peripheral blood at five time points,measuring the concentration of samples of SP and IL- 6. Moreover,pain visual analog scale（ VAS） and Hospital for Special Surgery（ HSS） knee score were used for evaluation of the patients knee function.[Results] At 6 h,12 h and 24 h postoperatively,SP in the plasma were [（ 103. 38 ± 8. 25）,（ 121. 74 ± 8. 75）,（ 101. 61 ±6. 13） ] pg / ml in the PEPMA group,while [（ 112. 87 ± 6. 02）,（ 134. 44 ± 7. 05）,（ 108. 91 ± 6. 47） ] pg / ml in the POMA group,associated with statistical significance in difference between the two groups at each time point（ P〈0. 01）. Likewise,IL- 6 in the serum existed [（ 48. 43 ± 10. 12）,（ 61. 84 ± 12. 53）,（ 43. 31 ± 11. 13） ] pg / ml in the PEPMA group,whereas[（ 67. 31 ± 12. 03）,（ 93. 24 ± 36. 51）,（ 61. 21 ± 10. 39） ] pg/ml in the POMA group respectively,with significant difference between the two groups（ P〈0. 01）. Additionally,VAS scores in the PEPMA group were significantly lower than those in the POMA group（ P〈0. 01）. Furthermore,HSS scores in the PEPMA group were significantly higher than in the POMA group at 3 days postoperatively（ P〈0. 01）. [Conclusion] Perioperative procedural multimodal analgesia is a better tactic to reduce the levels of SP and IL- 6 in the blood,manage pain,and improve early recovery of the knee function after total knee replacement.

关 键 词：全膝关节置换术 围手术期 镇痛 P物质 白细胞介素-6 视觉模拟评分 

分 类 号：R687.4[医药卫生—骨科学]