新型“鸡尾酒”局部浸润镇痛在人工全髋关节置换术后的镇痛效果观察——一项前瞻性随机对照研究  

Analgesic effect of a new“cocktail”of local infiltration analgesia after total hip arthroplasty——A prospective randomized controlled study

作　　者：阳强 王浩洋[1] 肖强[1] 罗振宇[1] 周宗科 YANG Qiang;WANG Haoyang;XIAO Qiang;LUO Zhenyu;ZHOU Zongke(Department of Orthopedics,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Orthopedics,People's Hospital of Jingyan County,Jingyan Sichuan,613100,P.R.China)

机构地区：[1]四川大学华西医院骨科骨科研究所,成都610041 [2]井研县人民医院骨科,四川井研613100

出　　处：《中国修复重建外科杂志》2022年第12期1485-1491,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金青年基金(81702128);四川省科学技术厅项目(18ZDYF2329)。

摘　　要：目的探讨加入得宝松的新型“鸡尾酒”局部浸润镇痛(localinfiltrationanalgesia,LIA)在人工全髋关节置换术(totalhiparthroplasty,THA)后的镇痛效果。方法采用前瞻性随机对照研究,纳入2018年1月—12月四川大学华西医院收治的因髋关节疾病需行单侧初次THA的100例患者,采用随机数字表法分为观察组和对照组,每组50例。两组患者年龄、性别构成、手术侧别、疾病种类、身体质量指数、美国麻醉医师协会(ASA)分级以及术前静息和活动疼痛视觉模拟评分(VAS)、髋关节Harris评分(HHS)、生活质量评定量表(SF-12)评分等一般资料比较差异均无统计学意义(P>0.05)。观察组患者在缝合切口前于髋关节周围使用新型“鸡尾酒”LIA,药物配方为罗哌卡因200mg、得宝松1mL、吗啡10mg,加生理盐水至80mL;对照组不做任何处理。记录两组患者手术时间、术后住院时间、住院期间吗啡用量以及出院时术侧髋关节活动度,并统计并发症发生情况;记录手术前后患者静息和活动状态下术侧髋关节VAS评分、HHS评分和SF-12评分[包括生理评分(PCS)和心理评分(MCS)],并对术后镇痛效果和髋关节功能恢复情况进行患者满意度调查。结果两组患者手术时间比较差异无统计学意义(P>0.05),观察组术后住院时间明显短于对照组(P<0.05)。观察组术后吗啡用量明显少于对照组(P<0.05),住院期间吗啡总用量少于对照组,但差异无统计学意义(P>0.05)。两组患者均随访至术后6个月。观察组术后2、6、12h及术后第1天上、下午静息VAS评分明显低于对照组,术后6、12h及术后第1天上、午活动VAS评分明显低于对照组,差异均有统计学意义(P<0.05);出院当天及术后3、6个月两组静息和活动VAS评分比较差异均无统计学意义(P>0.05)。出院时观察组髋关节屈曲活动度明显大于对照组(P<0.05),但两组髋关节外展活动度比较差异无统计学意义(P>0.05)。术后3、6�Objective To study the analgesic effect of a new“cocktail”of local infiltration analgesia(LIA)with Deprosone after total hip arthroplasty(THA).Methods In a prospective randomized controlled study,100 patients with hip joint disease requiring unilateral primary THA in West China Hospital of Sichuan University between January2018 and December 2018 were enrolled and randomly divided into observation group and control group,with 50 cases in each group.There was no significant difference in age,gender,operative side,disease type,body mass index,American Society of Anesthesiologists(ASA)classification,preoperative rest and activity visual analogue scale(VAS)score,hip Harris score(HHS),quality of life scale(SF-12)score,and other general data between the two groups(P>0.05).The patients in the observation group were treated with a new“cocktail”LIA around the hip joint before suturing the incision,and the drug formula was ropivacaine 200 mg,Diprospan 1 mL,morphine 10 mg,and added normal saline to 80 mL;the patients in the control group were not treated with LIA.The operation time,postoperative hospital stay,the amount of morphine used during hospitalization,and the range of motion of hip joint at discharge were recorded,and the complications were counted.The VAS score at rest and activity,HHS score,and SF-12 score[physiological score(PCS)and psychological score(MCS)]of the hip joint were recorded before and after operation,and the postoperative analgesic effect and the recovery of hip joint function were evaluated.Results There was no significant difference in the operation time between the two groups(P>0.05),and the postoperative hospital stay in the observation group was significantly shorter than that in the control group(P<0.05).The postoperative morphine consumption in the observation group was significantly less than that in the control group(P<0.05),and the total morphine consumption in the observation group was less than that in the control group during hospitalization,but the difference was not significant

关 键 词：人工全髋关节置换术 “鸡尾酒”疗法 局部浸润镇痛 得宝松 多模式镇痛 

分 类 号：R614[医药卫生—麻醉学]