酮咯酸氨丁三醇超前镇痛联合术后静脉自控镇痛用于全膝关节置换术的临床研究  

Clinical study on ketorolac tromethamine preemptive analgesia combined with postoperative patient-controlled intravenous analgesia in total knee replacement

作　　者：宋海龙 张雁[1] SONG Hailong;ZHANG Yan(Department of Anesthesiology,Heze Municipal Hospital in Shandong Province,Heze,Shandong,274900)

机构地区：[1]山东省菏泽市立医院麻醉科,山东菏泽274900

出　　处：《实用临床医药杂志》2020年第20期18-21,共4页Journal of Clinical Medicine in Practice

摘　　要：目的观察酮咯酸氨丁三醇(KT)超前镇痛联合术后静脉自控镇痛(PCIA)用于全膝关节置换术(TKR)的临床效果。方法将84例TKR患者随机分为对照组和观察组,每组42例。对照组单纯采用术后PCIA,观察组采用KT超前镇痛联合术后PCIA。比较2组患者术后首次下床时间、术后48 h内镇痛泵按压次数和术后24、48 h视觉模拟评分法(VAS)评分、血清促炎因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)、白细胞介素-8 (IL-8)]、血清应激指标[血清皮质醇(Cor)、肾上腺皮质激素(ACTH)]水平,并比较2组患者治疗期间不良反应发生情况。结果观察组术后首次下床时间早于对照组,术后48 h内镇痛泵按压次数少于对照组,差异有统计学意义(P <0.05);术后24、48 h,观察组VAS评分和TNF-α、IL-6、IL-8、Cor、ACTH水平均低于对照组,差异有统计学意义(P <0.05);术后镇痛期间,2组均发生1例恶心呕吐,不良反应发生率比较,差异无统计学意义(P> 0.05)。结论 KT超前镇痛联合术后PCIA用于TKR可缩短术后首次下床时间,减少术后48 h内镇痛泵按压次数,有效缓解患者疼痛,减轻TKR后炎性反应和应激反应,且安全性高。Objective To observe the clinical efficacy of ketorolac tromethamine (KT) preemptive analgesia combined with postoperative patient-controlled intravenous analgesia (PCIA) in total knee replacement (TKR). Methods A total of 84 TKR patients were randomly divided into control group and observation group. The control group (n = 42) was only given postoperative PCIA,while observation group (n = 42) was given KT preemptive analgesia combined with postoperative PCIA.The postoperative time to first getting out of bed,number of analgesia pump presses within 48 h after surgery,scores of Visual Analogue Scale (VAS) at 24 h and 48 h after surgery,serum pro-inflammatory factors [tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),interleukin-8 (IL-8) ]and serum stress indexes [serum cortisol (Cor),adrenocortical hormone (ACTH) ],and occurrence of adverse reactions during treatment were compared between the two groups. Results The postoperative time to first getting out of bed in observation group was earlier,and number of analgesia pump presses within 48 h after surgery was significantly less than that in control group (P < 0. 05). At 24 h and48 h after surgery,VAS scores,levels of TNF-α,IL-6,IL-8,Cor and ACTH in the observation group were significantly lower than those in control group (P < 0. 05). During postoperative analgesia,the two groups occurred nausea and vomiting in one case. There was no significant difference in incidence of adverse reactions between the two groups (P > 0. 05). Conclusion KT preemptive analgesia combined with postoperative PCIA for TKR can shorten postoperative time to first getting out of bed,reduce number of analgesia pump presses within 48 h after surgery,effectively alleviate pain,inflammatory reactions and stress response after TKR,and it has higher safety.

关 键 词：酮咯酸氨丁三醇 静脉自控镇痛 全膝关节置换术 促炎因子 

分 类 号：R687.4[医药卫生—骨科学]