多模式镇痛在膝关节骨折围手术期的临床疗效分析  

Clinical effect of multimodal analgesia in perioperative pain control of knee fracture

作　　者：陈文韬[1] 白晓冬[1] 王宝军[1] 李修良[2] 高化[1] 刘振宇[1] 李亚东[1] 赵亮[1] CttEN Wen-tao;BAI Xiao-dong;WANG Bao-jun(Department of Orthopaedic,Bejing Frienship Hospital,Capital Medical Universtiy,Beijing 100050,China.)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2018年第18期1980-1983,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金青年科学基金项目(编号:81701203)

摘　　要：目的比较多模式镇痛和传统药物在膝关节骨折围手术期的镇痛疗效。方法前瞻性选取2016年1月至2017年12月于首都医科大学附属北京友谊医院行内固定手术的膝关节骨折患者96例,按数字随机表将患者(单盲)随机分为两组:传统药物组(n=46)及多模式镇痛组(n=50)。传统药物组口服塞来昔布(200 mg,每12 h一次,持续至术后2周);多模式镇痛组口服塞来昔布(200 mg,每12 h一次,持续至术后2周)+自控静脉舒芬太尼(30μg/(kg·L),持续2 ml/h泵入,单次)+静脉注射帕瑞昔布(40 mg,每12 h一次,持续3 d)。记录术前1 d、术后12 h、术后1 d、术后2d、术后3 d、术后2周的VAS评分、膝关节活动度、屈曲90°所需时间和不良反应的发生率。结果传统药物组术前1 d、术后12 h、术后1 d、术后2 d、术后3 d、术后2周的VAS评分为7.50±0.69分、5.72±0.72分、5.13±0.50分、4.26±0.61分、3.43±0.50分、2.48±0.55分,多模式镇痛组术前1 d、术后12 h、术后1 d、术后2 d、术后3 d、术后2周的VAS评分为7.28±0.61分、5.52±0.58分、4.74±0.66分、3.80±0.57分、3.00±0.61分、1.96±0.49分,术后1 d、术后2d、术后3 d、术后2周两组的VAS评分差异具有统计学意义(P<0.05),多模式镇痛组优于传统药物组;传统药物组术后1 d、术后2 d、术后3 d、术后2周的膝关节活动度为50.74±2.95°、59.98±1.47°、71.83±2.71°、93.24±4.87°,多模式镇痛组术后1 d、术后2 d、术后3 d、术后2周的膝关节活动度为55.4±8.53°、64.84±6.75°、76.88±8.11°、101.50±7.89°,术后1 d、术后2 d、术后3 d、术后2周膝关节活动度多模式镇痛组优于传统药物组,差异具有统计学意义(P<0.05)。传统药物组患者膝关节屈曲至90°的时间为(10.0±1.7)d,多模式镇痛组为(7.3±1.0)d,多模式镇痛组短于传统药物组,差异具有统计学意义(P<0.05)。传统药物组和多模式镇痛组的不良反应发生率分别为13%和22%,两组之间差异无统计学意�Objective To compare the clinical effect of multimodal analgesia and traditional drug in perioperative pain control of knee fracture. Methods A total of 96 knee fractures performed internal fixation in Bejing Frienship Hospital,Capital Medical Universtiy from January2016 to December 2017,were randomly divided into two groups. Group with traditional drug including 46 patients,taking Celecoxib. Group with multimodal analgesia including 50 patients,taking celecoxib（oral administration,200 mg,every 12 hour,to postoperative 2 weeks） ＋ sufentanil[30 μg/（kg·L） ],2 ml/h continuing microdosis venous pump,once） ＋ Parecoxib（intravenous injection,40 mg,every 12 hour,continual 3 days）. The data of VAS（visual analog scale）,Range of mobility（ROM）,time to mobility of 90 degrees and incidence of adverse effect was collected. Results VAS of the preoperative 1 d and postoperative12 h,1 d,2 d,3 d,2 weeks in group with traditional drug were 7. 50 ± 0. 69,5. 72 ± 0. 72,5. 13 ± 0. 50,4. 26 ± 0. 61,3. 43 ± 0. 50,2. 48 ± 0. 55,VAS of the preoperative 1 d and postoperative12 h,1 d,2 d,3 d,2 weeks in group with multimodal analgesia were 7. 28 ± 0. 61,5. 52 ± 0. 58,4. 74 ± 0. 66,3. 80 ± 0. 57,3. 00 ± 0. 61,1. 96 ± 0. 49. ROM of postoperative 1 d,2 d,3 d,2 weeks in group with traditional drug were 50. 74 ± 2. 95°,59. 98 ± 1. 47°,71. 83 ± 2. 71°,93. 24 ± 4. 87°,ROM of postoperative 1 d,2 d,3 d,2 weeks in group with multimodal analgesia were 55. 4 ± 8. 53°,64. 84 ± 6. 75°,76. 88 ± 8. 11°,101. 50 ± 7. 89°. There was significant difference of VAS and ROM between two groups on postoperative 1 d,2 d,3 d,2 weeks（P〈0. 05）. Group with multimodal analgesia was better than group with traditional drug. Time to 90 degrees in group with multimodal analgesia was（7. 3 ± 1. 0） days,significantly shorter than group with traditional drug with（10. 0 ± 1. 7） days（P〈0. 05）. Incidence of adverse effect in group with traditional drug and group with multimodal analgesia was 13% and 22%. Th

关 键 词：膝关节骨折 多模式镇痛 塞来昔布 帕瑞昔布 舒芬太尼 

分 类 号：R687.3[医药卫生—骨科学]