局部浸润镇痛在老年全膝关节置换术多模式镇痛中的临床研究  

Clinical study of the local infiltration analgesia in multimodal analgesia of senile patients undergoing total knee replacement

作　　者：张佳林[1] 赵敏[1] 张桂珍[1] 蔺治凯[1] 乔永东[1] ZHANG Jialin;ZHAO Min;ZHANG Guizhen;LIN Zhikai;QIAO Yongdong(Department of Spine and Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院脊柱骨科,宁夏银川750004

出　　处：《宁夏医学杂志》2022年第12期1087-1090,共4页Ningxia Medical Journal

基　　金：宁夏医科大学校级科研课题(XM2018144)。

摘　　要：目的 探讨局部浸润镇痛在老年全膝关节置换术(TKA)多模式镇痛(MMA)中的效果。方法 选择收治的行单侧全膝关节置换术患者80例为研究对象,随机分为局部浸润镇痛组和对照组各40例。术中局部浸润镇痛组采用“鸡尾酒”法镇痛,对照组直接缝合切口,观察2组患者静息以及运动状态下VAS评分、主动膝关节活动度及屈曲达90°所需时间、股四头肌肌力情况,以及术后阿片类药物服用情况和所发生的不良反应。结果 局部浸润镇痛组术后12、24、48、72 h处于静息以及运动状态下时VAS评分低于对照组,差异有统计学意义(P<0.05);2组术后1周至2周处于静息时VAS评分对比差异无统计学意义(P>0.05)。术后第1周局部浸润镇痛组膝关节活动度优于对照组(P<0.05);局部浸润镇痛组术后膝关节屈曲达90°所需时间低于对照组,2组差异有统计学意义(P<0.05)。2组术后3 d内股四头肌肌力比较差异无统计学意义(P>0.05)。局部浸润镇痛组术后辅助使用阿片类药物显著低于对照组(P<0.05),局部浸润镇痛组不良反应发生率显著低于对照组(P<0.05)。结论 在多模式镇痛的基础上,TKA术中使用关节浸润镇痛药物的方式,短期内明显减轻术后疼痛,进而增强了膝关节活动度,且降低阿片类药物的使用和不良反应的发生率。Objective To investigate the effect of local infiltration analgesia on multimodal analgesia(MMA) in senile patients undergoing total knee replacement(TKA).Methods 80 senile patients with unilateral total knee osteoarthritis who needed replacement were selected and randomly divided into local infiltration analgesia group(40 cases) and control group(40 cases). The "cocktail" analgesia was used in the local infiltration analgesia group, while the directly sutured incision were used in the control group. The VAS score in resting and dynamic state, the active knee range of motion and the required time for flexion to reach 90°,the quadriceps femoris muscle strength, the use of opioids and adverse reactions after surgery were observed in the two groups of patients at rest and in motion.Results The VAS scores in the local infiltration analgesia group were significantly lower than those in the control group at 12,24,48,72 h after operation in resting and dynamic state(P<0.05). There was no significant difference in VAS scores between the two groups in resting from 1 week to 2 weeks after operation(P>0.05). The range of motion of the knee joint in the local infiltration analgesia group was better than that in the control group at the first week after operation(P<0.05). The time required for knee flexion to reach 90° after surgery in the local infiltration analgesia group was lower than that in the control group(P<0.05). There was no significant difference in quadriceps femoris muscle strength between the two groups within 3 days after operation(P>0.05). The adjunctive use of opioids in the local infiltration analgesia group was significantly lower than that in the control group(P<0.05),and the incidence of adverse reactions in the local infiltration analgesia group was significantly lower than that in the control group(P<0.05).Conclusion On the basis of multimodal analgesia, the use of joint-infiltration analgesics during TKA can significantly reduce postoperative pain in a short term, thereby enhancing the range of moti

关 键 词：局部浸润镇痛 全膝关节置换术 多模式镇痛 

分 类 号：R614.32[医药卫生—麻醉学]