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全膝关节置换术后多模式镇痛方案的临床研究 预览 被引量:9

Multimodal Analgesia Methods for Postoperative Pain Management after Total Knee Arthroplasty
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摘要 目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)术后镇痛的最佳方案。方法首次行TKA患者80例,随机分成4组(n=20):对照组(C组)、帕瑞昔布组(P组)、曲马多组(T组)和芬太尼组(F组)。各组术前行术侧股神经置管,从术后1 h开始,每隔6 h(至术后48 h),由导管注入0.2%罗哌卡因15 mL。C组:当视觉模拟评分(VAS评分)〉5时,静脉给予生理盐水2 mL,随后视疼痛情况每隔6 h可再静注生理盐水2 mL。P组:当VAS评分〉5时,静脉给予帕瑞昔布40 mg,随后视疼痛情况每隔6 h可再静注帕瑞昔布20 mg,每天总剂量不超过80 mg。T组:当VAS评分〉5时,静脉给予帕瑞昔布40 mg,10 min后若VAS评分仍大于5,静脉给予曲马多50 mg,随后视疼痛情况每隔6 h可再静注曲马多50 mg。F组:当VAS评分〉5时,静脉给予帕瑞昔布40 mg,10 min后若VAS评分仍大于5,静脉给予曲马多50 mg;15 min后若VAS评分仍大于5,静脉给予芬太尼30μg;随后视疼痛情况每隔6 h可再静注芬太尼50μg。术后每8 h记录VAS评分和镇静评分;术后48 h记录不良反应的发生率并进行患者满意度调查。结果术后各时点的VAS评分,C组显著高于P组、T组和F组(均P〈0.05),P组高于T组和F组(均P〈0.05),而T组与F组之间差异无统计学意义(P〉0.05)。术后48 h内过度镇静、恶心、呕吐的发生率,F组显著高于C组、P组和T组(均P〈0.05)。患者满意度调查,T组显著高于C组、P组和F组(均P〈0.05)。结论连续股神经阻滞与阶梯镇痛(帕瑞昔布和曲马多)相结合是TKA术后镇痛的一种理想方案。 Objective To find an optimal method for postoperative pain management after total knee arthroplasty(TKA).Methods Eighty patients subject to unilateral TKA were randomly divided into 4 groups(n=20 each):control group(C group),parecoxib group(P group),tramadol group(T group),fentanyl group(F group).All the patients were infused with 15 mL of 0.2% ropivacaine via femoral nerve catheter at the first h after surgery and from then on per 6 h postoperatively till 48 h postoperatively.If the visual analogue score(VAS)5 the supplements(parecoxib,tramadol,fentanyl)would be infused in turn till the patient felt comfortable or the analgesic effect reached the clinical maximum.The VAS and sedation score(SS)were recorded per 8 h after surgery.Side effects and degree of satisfaction were investigated at the 48th h after surgery.Results In C group VAS was significantly higher than in P,T,F groups(P0.05)and that in P group was significantly higher than in T,F groups(P0.05).There was no significant difference in VAS between T and F groups(P0.05).The incidence of side effects was significantly higher in F group than in C,P,T groups(P0.05)and the T group had a significantly higher degree of satisfaction than in C,P,F groups(P0.05).Conclusion Continuous femoral nerve block compound with parecoxib and tramadol is the optimal method for postoperative pain management after TKA.
作者 李传翔 宋伏虎 王怡 金大地 陈力 宋冬梅 Li Chuanxiang,Song Fuhu,Wang Yi et al Department of Anesthesiology,Third Affiliated Hospital of SouthernMedical University,Guangzhou 510630,China
出处 《华中科技大学学报:医学版》 CAS CSCD 北大核心 2010年第6期 793-796,共4页 Journal of Huazhong University of Science and Technology(Health Sciences)
关键词 全膝关节置换术 镇痛 神经传导阻滞 阶梯止痛 total knee arthroplasty analgesia nerve block step analgesia
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