加速康复下全膝关节置换术后急性疼痛多因素分析及对策  

Multiple Factors Analysis and Countermeasures of Accelerating Acute Pain after Total Knee Replacement under Rehabilitation

作　　者：侯晓玲[1] 谢小伟[1] 涂晓晴 詹瑜佳[1] 李玲利[1] Hou Xiaoling;Xie Xiaowei;Tu Xiaoqing;et al(Department of Orthopedics, West China Hospital, Sichuan University , Chengdu , Sichuan 610041, China)

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《四川医学》2018年第4期379-382,共4页Sichuan Medical Journal

基　　金：四川省科技厅科技支撑计划项目(编号:2016FZ0075)

摘　　要：目的探讨影响TKA术后急性疼痛的相关因素,以期为TKA术后患者急性疼痛的管理提供参考依据。方法2016年5月至2016年9月连续纳入200例拟行初次单侧TKA的患者,收集患者性别、年龄、体质量指数、ASA评分、VAS评分、手术时间、心晴指数、睡眠质量评分等情况,以及术后前3d的VAS评分,并利用多因素Logistic分析术后急性疼痛严重程度的相关危险因素。结果 200例TKA患者中,男46例,女154例;年龄43~78岁,平均年龄(63.54±11.37)岁;其中骨关节炎162例,类风湿关节炎30例,创伤性关节炎8例。单因素分析显示性别、年龄、ASA评分、类风湿关节炎、糖尿病、心晴指数、手术时间、冰敷时间及睡眠质量与术后急性疼痛的严重程度呈相关性。进一步,多因素Logistic回归分析发现女性(OR=2.55,P=0.001)、大于60岁(OR=2.12,P=0.011)、ASA评分(OR=2.23,P=0.001)、类风湿关节炎(OR=2.09,P=0.017)、糖尿病(OR=2.89,P=0.009)、心晴指数(OR=0.39,P=0.012)、手术时间>90min(OR=2.55,P=0.001)、冰敷>24h(OR=0.41,P=0.01)及睡眠质量评分(OR=0.52,P=0.01)为术后疼痛的危险因素。结论初次全膝关节置换术后急性疼痛可以影响患者术后住院时间及患者满意度,其中患者的性别、年龄、ASA评分、类风湿关节炎、糖尿病、心晴指数、手术时间、冰敷时间及睡眠质量可能是术后疼痛的相关危险因素。Objective To discuss the related factors affecting the acute pain after TKA in order to provide reference for the management of acute pain for patients after TKA operation. Methods From May 2016 to September 2016,a total of 200 patients planned to take unilateral TKA for the first time were collected,and we collected the patient sex,age,body mass index,ASA score,VAS score,operation time,mood index,sleep quality score,and VAS score the first three days after the operation of the patients,and multivariate Logistic analysis was used to analyse the relative risk factors of the severity of acute postoperative pain.Results Among 200 TKA patients,there were 46 males and 154 females. The age was 43 ~ 78 years old,with an average age of（ 63. 54±11. 37） years,including 162 cases of osteoarthritis,30 cases of rheumatoid arthritis and 8 cases of traumatic arthritis.Univariate analysis showed the correlation between the severity of acute postoperative pain and gender,age,ASA score,rheumatoid arthritis,diabetes,mood index,operation time,ice time and quality of sleep.Further,multivariate Logistic analysis showed that female（ OR= 2. 55,P= 0. 001）,more than 60 years old（ OR= 2. 12,P= 0. 011）,ASA score（ OR = 2. 23,P = 0. 001）,rheumatoid arthritis（ OR= 2. 09,P= 0. 017）,diabetes mellitus（ OR = 2. 89,P = 0. 009）,mood index（ OR = 0. 39,P = 0. 012）,operation time90 min（ OR= 2. 55,P= 0. 001）,ice time〉24 h（ OR= 0. 41,P= 0. 01） and sleep quality score（ OR= 0. 52,P= 0. 01） were the risk factors of postoperative pain.Conclusion Acute pain after first-time total knee arthroplasty can affect the postoperative hospitalization time and patient satisfaction,the gender,age,ASA score,rheumatoid arthritis,diabetes,mood index,operation time,ice time and sleep quality may be the risk factors for postoperative pain.

关 键 词：全膝关节置换术 术后疼痛 相关因素 

分 类 号：R687.4[医药卫生—骨科学]