多模式镇痛法在老年人工膝关节置换术后早期的应用  

Application of multimodal analgesia in early stage of elderly patients with artificial knee arthroplasty

作　　者：祖曙芳 徐晓栋[1] 田锐 ZU Shufang;XU Xiaodong;TIAN Rui(Department of Anesthesiology,Hefei Third Clinical College,Anhui Medical University(the Third People’s Hospital of Hefei),Anhui Province,Hefei230031,China;Clinical Medical College of Anhui Medical University,Anhui Province,Hefei230031,China)

机构地区：[1]安徽医科大学合肥第三临床学院(合肥市第三人民医院)麻醉科,安徽合肥230031 [2]安徽医科大学临床医学院,安徽合肥230031

出　　处：《中国医药导报》2021年第22期117-120,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81502323)。

摘　　要：目的探讨多模式镇痛法在老年人工膝关节置换术后早期的应用。方法选取2016年1月至2020年4月安徽医科大学合肥第三临床学院(合肥市第三人民医院)收治的80例实施人工膝关节置换术的老年患者,采用随机数字表法分为常规组[40例,予以静脉自控镇痛(PCIA)]和研究组(40例,予以多模式镇痛,即PCIA+超声引导下神经阻滞+物理镇痛)。比较两组术后塞来昔布胶囊使用剂量;比较两组术后12、24、48、72 h静息痛评分[视觉模拟评分(VAS)];比较两组术后即刻、术后24 h、术后72 h血清神经递质和应激反应水平变化。结果研究组塞来昔布胶囊使用剂量低于常规组,差异有统计学意义(P<0.05)。两组组内各时间点VAS评分比较,差异有统计学意义(P<0.05);研究组各时间点VAS评分低于常规组,差异有统计学意义(P<0.05)。两组组内各时间点P物质、β-内咖肽(β-EP)、5-羟色胺(5-HT)、皮质醇(Cor)、C反应蛋白(CRP)和白细胞计数(WBC)水平比较,差异有统计学意义(P<0.05);研究组术后24、72 h P物质、β-EP、5-HT、Cor、CRP、WBC水平低于常规组,差异有统计学意义(P<0.05)。结论对老年人工膝关节置换术后采用多模式镇痛法可减少剧烈疼痛发作,减轻术后疼痛,控制神经递质水平和应激反应。Objective To explore the application effect of multimodal analgesia in early stage of elderly patients with artificial knee arthroplasty.Methods From January 2016 to April 2020,80 elderly patients who underwent artificial knee arthroplasty in Hefei Third Clinical College,Anhui Medical University(the Third People’s Hospital of Hefei)were selected,and they were divided into routine group(40 cases,who were given patient-controlled intravenous analgesia[PCIA])and study group(40 cases,who were given multimodal analgesia,that was PCIA+ultrasound-guided nerve block+physical analgesia).Postoperative dose of Celecoxib Capsules was compared between two groups.The resting pain scores(visual analogue scale[VAS])were compared between two groups at 12,24,48,and 72 h after surgery.The changes levels of serum neurotransmitters and stress response were compared between two groups immediately after surgery,24 h after surgery,and 72 h after surgery.Results The dose of Celecoxib Capsules in study group was lower than that in routine group,and the difference was statistically significant(P<0.05).VAS scores were compared between two groups at each time point,and the differences were statistically significant(P<0.05);and VAS score of study group was lower than that of routine group at each time point,and the differences were statistically significant(P<0.05).There were significant differences in the levels of substance P,β-endorphin(β-EP),5-hydroxytryptamine(5-HT),cortisol(Cor),C-reactive protein(CRP),and white blood cell count(WBC)at each time point between two groups(P<0.05);and the levels of substance P,β-EP,5-HT,Cor,CRP,and WBC in study group at 24 and 72 h after surgery were lower than those in routine group,and the differences were statistically significant(P<0.05).Conclusion The application of multimodal analgesia in early stage of elderly patients with artificial knee arthroplasty can reduce severe pain attack,relieve postoperative pain,control neurotransmitter levels and stress response.

关 键 词：多模式镇痛法 老年人 人工膝关节置换术 疼痛 神经递质 应激反应 

分 类 号：R684.3[医药卫生—骨科学]