伤口局部浸润镇痛在全膝关节置换术后的应用  

Effect of Local Infiltration Analgesia after Total Knee Arthroplasty

作　　者：韩璇[1] 蔡洁[2] HAN Xuan CAI Jie(Department of Emergency, Wuhan General Hospital of Guangzhou Command, Wuhan Hubei 430070, Chin)

机构地区：[1]广州军区武汉总医院急诊科,湖北武汉430070 [2]广州军区武汉总医院骨科,湖北武汉430070

出　　处：《华南国防医学杂志》2016年第9期581-584,共4页Military Medical Journal of South China

摘　　要：目的比较伤口局部浸润镇痛和静脉自控镇痛(patient controlled intravenous analgesia,PCIA)在人工全膝关节置换术(total knee arthroplasty,TKA)后的有效性及安全性。方法收集2014-10/2015-12月在作者医院关节外科行单侧TKA的98例骨关节炎患者,随机分为局部浸润镇痛组和PCIA组,局部浸润组持续伤口给予0.8%利多卡因浸润镇痛,PCIA组使用1.2 mg芬太尼+120 ml生理盐水经静脉患者自控镇痛,用药至术后48 h,观察并记录术后6、12、24、48 h患者的静息痛和运动痛,术后48 h关节的活动度,患者满意度及术后48 h内的不良反应。结果术后6、12、24、48 h,浸润镇痛组的静息痛视觉模拟评分法(visual analogue scale,VAS)评分均小于PCIA组;术后6、12、24 h浸润镇痛组运动痛VAS评分均小于PCIA组;浸润镇痛组患者满意度明显高于PCIA组;PCIA组不良反应发生率明显高于浸润镇痛组,并且有1例患者出现伤口皮缘坏死,组间比较差异均具有统计学意义(P<0.05)。结论利多卡因局部浸润麻醉用于膝关节置换术后镇痛,效果确切,不良反应少。Objective To compare the efficacy and safety of local infiltration analgesia and patient controlled intra- venous analgesia （PCIA） after total knee arthroplasty （TKA）. Methods From October 2014 to December 2015,98 patients who underwent the primary TKA in the department of Orthopedics, were randomly divided into two groups：the local infiltration group and PCIA group, the local infiltration group received lidocaine at a concentration of 0. 5% for infiltration analgesia, and the PCIA group received 1.2 mg fentanyl and 120 ml normal saline for patient controlled intravenous analgesia, medication to 48 hours after operation. The rest pain and motion pain of patients at 6,12,24,48 hours after operation, the range of motion of the joint after 48 hours, the satisfaction of the patients and the adverse reactions within 48 hours after operation were observed and recorded. Results There were no significant difference in ages, body mass index （BMI）, genders, operation times of patients between two groups （P〉0. 05） ; at 6,12,24,48 hours after treatment, the rest pain assessed by visual analog seale（VAS） in infiltration analgesia group were lower than that in PCIA group （P〈0. 05） ; the VAS scores of motion pain in infiltration analgesia group were lower than that in PCIA group after 6,12,24 hours （P d0. 05） ; the 48 hours＇ pain score in infiltration analgesia group was less than that in PCIA group, but the difference was not statistically significant （P〉0. 05） ; 48 hours after surgery, the knee range of motion in PCIA group was slightly high-er than that in infiltration analgesia group, but the difference was not statistically significant （P〉0. 05）; the satisfaction of patients in infiltration analgesia group was significantly higher than that in PCIA group （P〈0. 05） ; the adverse reac-tions in PCIA group was significantly higher than that in infiltration analgesia group （P〈0. 05）, and one case in PCIA group had skin necrosis of the wound. Conclusion Local infiltrati

关 键 词：全膝关节置换术 局部浸润镇痛 经静脉患者自控镇痛 视觉模拟评分法 

分 类 号：R473[医药卫生—护理学]