多模式镇痛方式对全膝关节置换术后患者镇痛效果分析  

Analgesic Effect of Multi-mode Analgesia on Patients after Total Knee Replacement

作　　者：王敬[1] 张亚美[1] 罗珊 吴艳萍 孙卧林[1] 董雨[1] 王娟[1] WANG Jing;ZHANG Ya-mei;LUO San;WU Yan-ping;SUN Wo-lin;DONG Yu;WANG Juan(Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Heibei Provinve,Cangzhou,Hebei 061001,China)

机构地区：[1]河北省沧州中西医结合医院麻醉科

出　　处：《解放军医药杂志》2020年第2期98-101,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省卫生厅科研基金项目(20191288)

摘　　要：目的探究多模式镇痛方式对全膝关节置换术后患者镇痛效果。方法选取2018年1月-2018年12月我院行人工全膝关节置换术的患者120例,根据麻醉方式的不同分为4组,每组30例。A组采用股神经阻滞+超前镇痛+局部浸润麻醉,B组采用为股神经阻滞+超前镇痛,C组为单纯股神经阻滞组,D组采用静脉自控镇痛。观察并比较4组患者不同时间的疼痛视觉模拟评分(VAS)、关节活动度、简易智力状态量表(MMSE)评分、血浆白介素-6(IL-6)浓度及不良反应发生情况。结果A组患者术后12、24 h静息状态下VAS评分及术后12、24、48 h活动状态下VAS评分低于其他3组(P<0.05);A组患者术后4、7 d膝关节活动度大于其他3组(P<0.05);A组术后6、24、48 h血浆IL-6浓度及不良反应发生率低于其他3组(P<0.05)。结论多模式镇痛降低术后疼痛程度较好,促进运动功能恢复,减少炎性反应,降低不良反应发生率,值得临床推广使用。Objective To investigate analgesic effect of multi-mode analgesia on patients after total knee arthroplasty.Methods A total of 120 patients undergoing total knee arthroplasty during January 2018 and December 2018 were divided into four groups(n=30 in each group)according to different anesthesia methods.Group C was simple femoral nerve tissue group,and group B was femoral nerve block+preemptive analgesia group,while group A was femoral nerve block+preemptive analgesia+local infiltration anesthesia group,and group D was intravenous self-controlled analgesia group.Visual pain score(VAS)scores,joint range of motion,mini-mental state examination(MMSE)scores,plasma concentration of interleukin-6(IL-6)and incidence rate of adverse reactions were observed and compared at different time in four groups.Results VAS scores at 12 h and 24 h after operation under quiescent condition and at 12 h,24 h and 48 h after operation under active state in group A were significantly lower than those in other three groups(P<0.05).In group A,knee joint activities in 4 d and 7 d after operation were significantly higher(P<0.05),and plasma concentration of IL-6 at 6 h,24 h and 48 h after operation and incidence rate of adverse reactions were significantly lower than those in other three groups(P<0.05).Conclusion Multi-mode analgesia may reduce degree of postoperative pain,promote recovery of motor function,reduce inflammatory reaction and decrease incidence rate of adverse reactions.

关 键 词：关节成形术 置换 膝 骨关节炎 膝 多模式镇痛 白介素-6 疼痛测定 麻醉和镇痛 

分 类 号：R687.42[医药卫生—骨科学]