多模式镇痛联合康复训练在人工股骨头置换术后的应用效果  

Application Effect of Multimodal Analgesia Combined with Rehabilitation Training in Postoperative Artificial Femoral Head Replacement

作　　者：周硕果[1] 付萌萌 张现云 ZHOU Shuoguo;FU Mengmeng;ZHANG Xianyun(Pain Rehabilitation Department,Zhengzhou Third People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第三人民医院疼痛康复科,河南郑州450000

出　　处：《河南医学研究》2022年第8期1449-1453,共5页Henan Medical Research

摘　　要：目的探讨多模式镇痛联合康复训练在人工股骨头置换术患者中的效果。方法选取2020年12月至2021年9月在郑州市第三人民医院进行人工股骨头置换术治疗的96例患者为研究对象,按照随机数字表法分为研究组与对照组,各48例。两组患者术后均接受康复训练,研究组康复训练前接受多模式镇痛,对照组接受自控静脉镇痛。比较两组患者手术前(T0)、术后12h(T_(1))、术后24h(T_(2))及术后48h(T_(3))的Ramsay镇静情况、疼痛因子[P物质(SP)、5-羟色胺(5-HT)、组胺(HIS)]及神经元特异性烯醇化酶(NSE)、S-100β蛋白水平,使用简易智能精神状态检查量表(MMSE评分)评估认知功能;并于术前1d及术后1、3个月采用髋关节Harris评分评估患者髋关节功能。结果T_(1)、T_(2)及T_(3)时刻,研究组静息及运动状态下的视觉模拟评分、SP、5-HT、HIS、S-100β及NSE水平均低于对照组(P<0.05),MMSE评分高于对照组(P<0.05)。与T_(0)相比,两组患者T_(1)、T_(2)时的SP、5-HT、HIS、S-100β、NSE水平均升高(P<0.05)。术后1、3个月时,研究组髋关节Harris评分均高于对照组(P<0.05)。结论多模式镇痛联合康复训练应用于人工股骨头置换术患者可有效提高镇痛效果,改善患者的神经功能及髋关节功能。Objective To explore the effect of multimodal analgesia combined with rehabilitation training in postoperative artificial femoral head replacement.Methods A total of 96 patients who underwent artificial femoral head replacement in Zhengzhou Third People’s Hospital from December 2020 to September 2021 were prospectively selected as the research objects,and they were divided into study group and control group according to the random number table method,with 48 cases in each group.Two groups received rehabilitation training after operation,and the patients in study group received multimodal analgesia before rehabilitation training,and the patients in control group received patient controlled intravenous analgesia.The Ramsay sedation,pain factors[substance P(SP),5-hydroxytryptamine(5-HT),histamine(HIS)],neuron-specific enolase(NSE)and S-100β protein levels were compared between the two groups before surgery(A),12 hours(T_(0)),24 hours(T_(2))and 48 hours(T_(3))after operation,and cognitive function was assessed by mini-mental state examination(MMSE score),and hip function was evaluated by Harris score 1 day before operation and 1 and 3 months after operation.Results Compared between groups,at A,T_(2) and T_(3),the visual analogue scale at rest and during exercise,SP,5-HT,HIS,S-100p and NSE levels in study group were lower than those in control group(P<0.05),and the MMSE score was higher than that in control group(P<0.05).Compared with A,the levels of SP,5-HT,HIS,S-100β and NSE at A and T2 of two groups were increased(P<0.05).At 1 month and 3 months after operation,the Harris scores of hip joint in study group were higher than those in control group(P<0.05).Conclusion The application of multimodal analgesia combined with rehabilitation training in patients with artificial femoral head replacement can effectively improve the analgesic effect of patients,and improve the neurological function and hip function of patients.

关 键 词：人工股骨头置换术 多模式镇痛 康复训练 疼痛因子 髋关节功能 

分 类 号：R473.5[医药卫生—护理学]