不同局部浸润镇痛技术对前交叉韧带重建术后患者的镇痛效果  

Analgesia Effect of Different Location Infiltration Analgesia in Patients after Anterior Cruciate Ligament Reconstruction

作　　者：王岩民[1] 樊勇[1] 高强[1] 姚国华[2] 刘振峰 

机构地区：[1]新疆维吾尔自治区人民医院北院骨科,新疆乌鲁木齐830054 [2]新疆维吾尔自治区人民医院北院麻醉科,新疆乌鲁木齐830054 [3]新疆维吾尔自治区中医医院骨科,新疆乌鲁木齐830000

出　　处：《现代生物医学进展》2016年第21期4058-4061,共4页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区中医民族医药人才培养计划项目(Q2015-03-12)

摘　　要：目的:比较关节内与关节周围浸润镇痛对前交叉韧带重建术(ACLR)后患者的镇痛效果。方法:选择2014年1月至2015年11月在我院拟行ACLR的前交叉韧带断裂患者40例,将其随机分为关节内浸润镇痛组(IA组)与关节周围浸润镇痛组(PA组),每组20例。两组均于术前3d定时口服塞来昔布(200mg,bid),术前0.5h行股神经阻滞(3.3g/L罗哌卡因30mL)。术中IA组于关节内给予30mL复合镇痛药物,而PA组于关节周围滑膜内注射相同药物。术后均给予24h冰敷治疗。观察两组患者术后12-72h及出院时的静息与活动疼痛视觉模拟评分(VAS),术后24-72h及出院时膝关节活动度,记录患者术后吗啡用量及不良反应情况。结果:PA组术后12-72h在静息与活动时以及在出院当天的活动时,VAS评分均显著低于IA组(P<0.05)。术后24-72hPA组关节活动度均优于IA组(P<0.05)。术后IA组、PA组吗啡镇痛使用率分别为30%、15%,且IA组吗啡平均用量为(10.3±1.1)mg,明显高于PA组的(5.4±0.9)mg(P<0.05)。两组不良反应率比较差异无统计学意义(P>0.05)。结论:关节周围浸润镇痛为主的多模式镇痛对ACLR围手术期患者的镇痛效果更好,更有利于关节功能的康复,值得临床推广应用。Objective： To compare the analgesia effect between Intra-articular and periarticular infiltration analgesia in patients after anterior cruciate ligament reconstruction（ACRL）. Methods： Selected 40 patients with anterior cruciate ligament rupture who were scheduled to undergo ACLR in our hospital from January 2014 to November 2015, they were randomly divided into intra-articular infiltration analgesia group（IA group, n=20）and periarticular infiltration analgesia group（PA group, n=20）. All the patients were given Celecoxib（200 mg, bid）at a definite time 3 d before the surgery, and underwent femoral nerve block（Ropivacaine 3.3 g/L, 30 m L）0.5 h before the surgery. The IA group was given 30 m L combined analgesia drugs intra-articular, while the PA group was given the same drugs through periarticular. Both the two groups were used ice therapy for 24 h after surgery. The Visual Analogue Scale（VAS）scores at rest and motion in 12-72 h after surgery and on discharge day, as well as the range of motion in 24-72 h after surgery and on discharge day in two groups were observed, the adverse reactions and postoperative morphine consumption were recorded. Results： The VAS scores in the PA group were lower than IA group at rest（12-72 h）and motion（12 h to discharge day）after surgery（P〈0.05）. The range of motion in the PA group were better than IA group in 24-72 h after surgery（P〈0.05）. The use rate of morphine analgesia in IA group and PA group were 30%,15% respectively, and the average doses of morphine in IA group was（10.3±1.1）mg, which was significantly higher than（5.4±0.9）mg in PA group（p0.05）. The adverse reactions of the two groups were no significant differences（P〉0.05）. Conclusion： In perioperative of ACRL, periarticular infiltration analgesia-based multimodal analgesia can obtain a nice analgesic effect and promote the rehabilitation of joint, which worth being widely applied in clinical field.

关 键 词：局部浸润镇痛 前交叉韧带重建术 多模式镇痛 股神经阻滞 

分 类 号：R686[医药卫生—骨科学] R614[医药卫生—外科学]