“医护一体化”多模式镇痛方案在初次行全膝关节置换术患者术后的应用效果  

Application Effect of“Medical and Nursing Integration”Multi-modal Analgesia Program in Patients Undergoing Total Knee Arthroplasty for the First Time

作　　者：郭海 朱勇 马开好 唐绍彦 钟伟华 苟凌云 GUO Hai;ZHU Yong;MA Kaihao;TANG Shaoyan;ZHONG Weihua;GOU Lingyun(Traumatic Joint Second Ward,Liuzhou Traditional Chinese Medicine Hospital(Liuzhou Zhuang Medical Hospital),Liuzhou 545000,China)

机构地区：[1]柳州市中医医院(柳州市壮医医院)创伤关节二病区,广西柳州545000

出　　处：《河南医学研究》2025年第6期1128-1133,共6页Henan Medical Research

基　　金：白求恩·医学科学研究基金项目(N163CS);广西区中医药管理局自筹课题项目(GXZYZ20210261)。

摘　　要：目的探讨“医护一体化”多模式镇痛方案在初次全膝关节置换术(TKA)后镇痛中的早期临床疗效。方法分析2019年9月至2021年9月柳州市中医医院创伤关节二病区收治的初次接受单侧TKA的膝骨关节炎患者50例,根据是否采用多模式镇痛方案设为无痛病房组和普通病房组,各25例,其中无痛病房组患者接受医护一体化的多模式镇痛方案,普通病房组患者接受传统镇痛方案。同期对比分析两组患者的一般资料及手术时间、术中出血、术后引流量、住院总天数、住院总费用、首次下床时间。对两组患者术后第1天、1周、2周、4周、12周静息和站立行走时视觉模拟评分(VAS)、膝关节活动度(ROM);两组患者术后第1周、2周、4周、12周的美国特种外科医院(HSS)膝关节功能评分,以及住院期间两组患者的满意度和睡眠质量评分进行两两对比。结果共48例纳入研究,统计结果发现,术后无痛病房组患者住院总时间、首次下地时间均短于普通病房组(P<0.05)。无痛病房组第1天、1周、2周、4周、12周静息时及行走时VAS评分均低于普通病房组(P<0.05)。无痛病房组术后第1天、1周、2周、4周、12周膝关节ROM、HSS评分均高于普通病房组(P<0.05);无痛病房组患者住院期间满意度、睡眠质量分数高于普通病房组(P<0.05)。无痛病房组并发症总人数占比低于普通病房组(P<0.05)。结论在无痛病房模式下,“医护一体化”的多模式镇痛方案有利于降低初次全膝关节置换手术患者的早期疼痛程度,促进术后康复,改善膝关节功能锻炼效果。Objective To explore the early clinical efficacy of the“integrated medical and nursing”multimodal analgesic program in analgesia after primary total knee arthroplasty(TKA).Methods To analyze 50 patients with knee osteoarthritis who underwent unilateral TKA for the first time who were admitted to the Traumatic Joint Second Ward of Liuzhou Traditional Chinese Medicine Hospital from September 2019 to September 2021.According to whether a multi-modal analgesic program was used to divide the pain-free ward group and the general ward group,25 patients in each group.Patients in the pain-free ward group received multi-modal analgesic program integrating medical care,patients in the general ward group received traditional analgesic program.The general information,operation time,intraoperative bleeding,postoperative drainage volume,total days of hospitalization,total hospitalization expenses,and first time out of bed were compared and analyzed statistically between the two groups during the same period.The visual analogue scale(VAS)scores and knee joint range of motion(ROM)at rest and while standing and walking were measured for the two groups of patients on the 1st day,1 week,2 weeks,4 weeks,and 12 weeks after surgery.The Hospital for Special Surgery(HSS)knee score of the two groups of patients at 1,2,4,and 12 weeks after surgery,and the satisfaction and sleep quality scores of the two groups of patients during hospitalization were compared.Results A total of 48 cases were included in the study,and the statistical results showed that the total hospitalization time and the first time to go to the ground in the postoperative pain-free ward group were shorter than those in the general ward group(P<0.05).The VAS scores of the pain-free ward group at rest and walking on the first day,1 week,2 weeks,4 weeks,and 12 weeks were lower than those of the general ward group(P<0.05).The ROM and HSS scores of the knee joint in the pain-free ward group were higher than those in the general ward group on the first day,1 week,2 weeks,4

关 键 词：全膝关节置换术 无痛病房 医护一体化 多模式镇痛 疼痛宣教 

分 类 号：R473.6[医药卫生—护理学]