摘要
目的研究局部浸润在全髋关节置换术（THA）后多模式镇痛（MA）的有效性和安全性。方法拟行初次单侧全髋关节置换的老年患者60例（年龄60～80岁）随机分为两组：局部浸润镇痛组和对照组。所有患者均于术前3d开始口服塞来昔布（200mg，2次／d），手术采用静脉、吸入复合麻醉。局部浸润镇痛组（n=30），于假体安置完成，缝合关节囊前于关节囊周围、切口周围浸润注射罗哌卡因2．5g／L，80ml，逐层关闭切口；对照组（n=30）直接缝合切口。术后两组患者均使用静脉患者自控式镇痛泵。观察2组患者术后4、24、48、72h和出院时的疼痛视觉模拟评分（visualanaloguescale，VAS）和术后24、48、72h及出院时术侧髋关节活动度，阿片类药物使用情况及镇痛相关不良反应发生率。结果患者术后48h内局部浸润镇痛组疼痛程度低于对照组，差异有统计学意义（t=0．258，P〈0．05），48h以后局部浸润镇痛组患者疼痛程度稍低于对照组，但结果差异无统计学意义（t=0．370，P〉0．05）。局部浸润镇痛组术后髋关节活动度优于对照组，差异有统计学意义（t=0．221，P〈0．05）；术后24h内局部浸润镇痛组要求使用补救性阿片类药物的人次显著低于对照组，恶心、呕吐等副反应发生率局部浸润镇痛组低于对照组。两组患者均未出现切口感染、下肢深静脉血栓（deepveinthrombosis，DVT）等全髋关节置换术相关严重并发症。结论采用局部浸润镇痛的多模式镇痛能有效缓解THA术后早期疼痛，减少患者对阿片类药物的需求，利于老年患者术后早期康复，而不增加THA术后严重并发症的发生率。多模式镇痛是老年患者THA术后安全、有效的镇痛方法。
Objective To study the efficiency and safety of the local infiltration analgesia for the patients who had accepted the muhimodal analgesia （MA） after total hip arthroplasty （THA）. Methods 60 cases of patients （average age, 70 ± 10 years） who were scheduled to the primary unilateral THA were randomized into two groups ： the local infiltration analgesia （LIA） group and the control group. Both of the two groups were given celecoxib （200 mg, two times a day） three days before the operation. A combination of intravenous anesthesia and inhaled anesthesia was used during the operation. In the LIA group （ n = 30） , the patients were given ropivaeaine （2. 5 g/L, 80 ml） around the joint capsule and the incisions by infiltrated injection after the prosthesis installed and before the joint capsule closed, then the incisions were sutured in layers. In the control group （ n = 30）, the incisions were sutured without the local infiltration analgesia. The patient-controlled analgesia pump was used in both groups. Visual analogue scale （VAS） was recorded respectively at 4, 24, 48, 72 hours postoperatively and at the discharge. The range of motionof the hip joint was measured respectively at 24, 48, 72 hours postoperatively and at the discharge. The use of opioids and the incidence of side effects related to analgesia were also recorded. Results The results showed the pain degree of the LIA group was lower than that of the control group within 48 hours postoperatively; the difference had statistical significance （P 〈 0. 05）. However, after 48 hours, the pain degree of the LIA group was slightly lower than that of the control group, the difference had no statistical significance （ P 〉 0.05 ）. The postoperative range of motion of the hip joint of the LIA group was better than that of the control group ; the difference was statistically significant （ P 〈 0. 05 ）. The number of the patients in the LIA group asked for remedial opioids within 24 hours postoperatively was significan
出处
《中华关节外科杂志（电子版）》
CAS
2014年第2期10-13,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
多模式镇痛
局部浸润镇痛
关节成形术
置换
髋
VAS评分
Muhimodal analgesia
Local infiltration analgesia
Total hip arthroplasty
Visual analogue scale
