全膝关节置换术老年患者围术期镇痛管理的优化方案  

Optimized strategy for perioperative analgesia management in the elderly undergoing total knee arthroplasty

作　　者：黎阳 刘金凤 李春莲 梁月影 王晨[1] 任蕾 于大勇[2] Li Yang;Liu Jinfeng;Li Chunlian;Liang Yueying;Wang Chen;Ren Lei;Yu Dayong(Department of Anesthesiology,Tianjin Third Central Hospital Branch,Tianjin 300250,China;Department of Anesthesiology,Tianjin People′s Hospital,Tianjin 300121,China)

机构地区：[1]天津市第三中心医院分院麻醉科,300250 [2]天津市人民医院麻醉科,300121

出　　处：《中华麻醉学杂志》2019年第12期1456-1460,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价全膝关节置换术老年患者围术期镇痛管理的优化方案。方法择期全麻下行单侧全膝关节置换术患者80例,年龄65~80岁,性别不限,BMI 18~31 kg/m^2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=40):常规镇痛管理组(A组)和围术期优化镇痛管理组(B组)。A组镇痛方案:术后病人自控收肌管阻滞。B组镇痛方案:术前进行疼痛宣教,患肢给予物理治疗、口服塞来昔布进行预防性镇痛;术中行膝关节切口周围注射镇痛;术后抬高患肢、切口周围冰敷、病人自控收肌管阻滞联合坐骨神经阻滞,静脉注射帕瑞昔布和口服塞来昔布镇痛。术后肌肉注射地佐辛进行补救镇痛。于术前第2、1天记录静态和动态VAS评分。记录镇痛泵有效按压次数、补救镇痛情况,记录术后改良Bromage运动阻滞分级情况和神经阻滞相关并发症和不良反应的发生情况。术前第2天、术后第3、7和14天记录膝关节纽约特种外科医院(HSS)评分,术前第2天与术后第14天记录膝关节活动度(ROM),术前第2天和术后第7天记录40项恢复质量量表(QoR-40)评分。结果与A组比较,B组术前第1天静态和动态VAS评分降低,术后镇痛泵有效按压次数和补救镇痛率降低,术后HSS评分和ROM升高,术后QoR-40评分中情绪状态、身体舒适度、疼痛评分和总评分升高(P<0.05),改良Bromage运动阻滞分级、不良反应发生率比较差异无统计学意义(P>0.05)。2组未见神经阻滞相关并发症发生。结论术前疼痛宣教和预防性镇痛、术中切口周围注射镇痛、术后病人自控神经阻滞及静脉注射和口服NSAIDs类药物是全膝关节置换术老年患者围术期镇痛管理的优化方案。Objective To investigate the optimized strategy for perioperative analgesia management in the elderly undergoing total knee arthroplasty.Methods Eighty patients of both sexes,aged 65-80 yr,with body mass index of 18-31 kg/m^2,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective unilateral total knee arthroplasty with general anesthesia,were divided into 2 groups(n=40 each)using a random number table method:conventional analgesia management group(group A)and optimized perioperative analgesia management group(group B).Analgesia management in group A:patient-controlled adductor canal block was performed after surgery.Analgesia management in group B:preoperative pain education was performed,physical treatment was performed in the affected limb and celecoxib was taken orally for preventive analgesia before surgery;injection analgesia was performed around knee incisions during surgery;the affected limb was elevated,ice compress was applied around the incision,patient-controlled adductor canal block combined with sciatic nerve block was performed,and intravenous parecoxib and oral celecoxib were given for analgesia after surgery.Dezocine was intramuscularly injected as rescue analgesic after surgery.Visual analog scale scores at rest and during activity were recorded on 2nd and 1st days before surgery.The effective pressing times of patient-controlled analgesia and requirement for rescue analgesia were recorded.Postoperative modified Bromage motor block grade,nerve block-related complications and adverse reactions were also recorded after surgery.The knee joint New York Hospital for Special Surgery score was recorded on 2nd day before surgery and 3rd,7th and 14th days after surgery.Knee range of motion was recorded on 2nd day before surgery and 14th day after surgery.The Quality of Recovery-40 scores were recorded on 2nd day before surgery and 7th day after surgery.Results Compared with group A,visual analog scale scores at rest and during activity were significantly decreased on 1st d

关 键 词：镇痛 关节成形术 置换 膝 

分 类 号：R614[医药卫生—麻醉学]