摘要
目的探讨采用围手术期多模式联合镇痛控制方法进行全膝关节置换术术后镇痛的临床疗效。方法 2008年3月至2009年6月期间对64例,64膝全膝关节置换术的患者采用围手术期多模式联合镇痛控制方法进行术后疼痛的治疗。围手术期疼痛综合控制包括:术前患者教育和应用环氧化酶(COX-2)抑制剂或曲马多缓释片超前镇痛;术中手术技术改进和减少手术创伤,术后予以医患沟通、冰敷及静脉自控镇痛(PCA)。术后第2天随机分为单用COX-2抑制剂和应用曲马多缓释片+COX-2抑制剂两组,并行主动功能锻炼;观察患者术后疼痛情况(VAS)包括静息痛、运动疼痛及膝关节出院时运动度恢复情况。结果联合镇痛组术后静息疼痛评分及运动疼痛评分比单用COX-2抑制剂组低,两者之间的差异有统计学意义。而两组在静息痛比较差异无统计学意义。术后两组膝关节运动活动度比较,差异有统计学意义。结论采用多模式联合镇痛,能有效地控制全膝关节比较置换手术后的运动疼痛,有利于关节功能的恢复。
Objective To investigate the clinical efficacy of a comprehensive pain control protocol for the postoperative pain after total knee Arthroplasty.Methods From Mar 2008 to Jun 2009,The post operative pain of 64 patients total knee Arthroplasty were treated with a comprehensive pain control protocol.The protocol encompasses preoperative psychological education and preemptive an algesia with COX-2 inhibitors or tramadol retard tablets,intraoperative reduction of surgical trauma and modification of surgical technique,postoperative psychological communication with patients,regular use of patient controlled analgesia in vein,cold compression and active functional exercise.64 total knees arthroplasty patients were enrolled into the trial.They were randomized either to receive a COX-2 inhibitor treatment or tramadol retard tablets＋ COX-2 inhibitors.Visual analog scores for postoperative,pain during rest and activity and the range of motion of the knee in discharge from hospital were recorded.Results There was statistical difference between two groups.less activity pain could be found in united analgesia Group than single-use COX-2 inhabitors.But there was no statistical difference between two groups in rest pain,and There was statistical difference between two groups.great motion range could be found in united analgesia Group.Conclusion The combination of comprehensive pain control protocol are more effective approach to control the postoperative activity pain of total knee arthroplasty and can lead to a quick functional recovery in patients with less complications.
出处
《重庆医学》
CAS
CSCD
北大核心
2010年第14期1871-1872,1874,共3页
Chongqing medicine
关键词
膝关节置换术
围术期
镇痛
total knee replacement
intraoperative period
analgesia
