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随着人均寿命的延长,越来越多的晚期膝关节疾病病人接受全膝关节置换术(total knee arthroplasty,TKA)的治疗。术后几天的早期疼痛仍然是临床急需解决的重要问题。降低术后早期疼痛的方法包括股神经阻滞、硬膜外镇痛、病人控制的静脉镇痛、连续关节内注射麻醉药。所有上述方法都会产生或多或少的问题,例如感染、尿潴留、恶心呕吐、神经损伤,最重要的是人为地延长了病人卧床时间[1]。近几年来新技术,术中应用关节腔内或者关节周围注射以罗哌卡因为主的“鸡尾酒”预防术后疼痛取得了良好的效果[2]。但如果采用关节周围注射罗哌卡因,由于罗哌卡因药物的半衰期为5 h以内,罗哌卡因会在术后第一天失去作用,且采用关节内注射罗哌卡因,由于引流管的引流作用,罗哌卡因会同样在术后第一天失去缓解疼痛作用。TKA术后24 h疼痛视觉模拟评分(visual analogue scale,VAS)显著升高[3]。术后第一天的反弹疼痛仍然是镇痛的重要挑战。本文旨在探讨全膝关节置换术后第一天关节腔内注射罗哌卡因对术后镇痛的早期疗效。
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在术后5 d的休息时间内,观察组的VAS评分曲线下面积低于对照组(424±32 vs 515±39,t=11.41,P < 0.01)。观察组在休息状态下,VAS平均疼痛评分均低于3.5阈值,而对照组在休息状态下,VAS平均疼痛评分有许多超过3.5阈值。
观察组术后第1天、2天VAS评分低于对照组(P < 0.05~P < 0.01)。2组术后第3天、4天、5天VAS评分差异无统计学意义(P>0.05)(见表 1)。
分组 n 术后1 d 术后2 d 术后2 d 术后3 d 术后4 d 术后4 d 术后5 d 12:00 07:00 20:00 12:00 07:00 20:00 12:00 20:00 12:00 07:00 20:00 12:00 07:00 20:00 观察组 40 2.0±0.9 2.1±1.1 2.8±1.3 2.9±1.5 3.1±1.5 3.5±1.5 3.0±1.2 3.3±1.3 3.0±1.3 2.7±1.3 2.9±1.0 3.0±1.0 2.6±0.9 2.5±0.7 对照组 40 3.6±1.5 4.2±1.8 3.9±1.7 3.7±1.6 4.2±1.7 3.9±1.6 3.3±1.3 3.8±1.4 3.4±1.5 2.9±1.2 3.3±1.6 3.2±1.2 2.7±0.8 2.5±0.9 t — 5.78* 6.30* 3.25 2.31 3.07 1.15 1.07 1.66 1.27 0.72 1.34 0.81 0.43 0.34 P — < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 *示t′值 表 1 2组术后休息状态不同时间点VAS评分比较(x±s)
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2组病人运动时膝关节疼痛差异无统计学意义(P>0.05)(见表 2)。
分组 n 术后1 d 术后2 d 术后3 d 术后4 d 术后5 d 观察组 40 4.3±1.6 5.0±1.8 4.7±1.5 4.5±1.4 3.7±1.3 对照组 40 4.9±1.7 5.3±1.6 4.9±1.5 4.9±1.5 3.9±1.0 t — 1.63 0.79 0.59 1.19 0.77 P — > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 表 2 2组术后运动状态不同时间点的VAS评分的比较(x±s)
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观察组术后的住院时间短于对照组,术后初次下地时间早于对照组(P < 0.01);2组非甾体类镇痛药物消耗量差异无统计学意义(P>0.05)(见表 3)。2组病人术后切口无表浅及深部感染,对照组1例病人出现切口脂肪液化,此病人连续换药后切口愈合良好。观察组注射部位无感染。
分组 n 术后住院时间/d 术后初次下地时间/d 非甾体类镇痛药消耗量/支 观察组 40 7.0±2.7 2.4±0.5 9.7±6.7 对照组 40 9.6±3.3 3.4±0.8 9.9±6.5 t — 3.86 6.70* 0.14 P — < 0.01 < 0.01 > 0.05 *示t′值 表 3 2组术后的住院时间、术后初次下地时间、镇痛药消耗量比较(x±s)
全膝关节置换术后第一天关节内注射罗哌卡因对术后镇痛的早期疗效分析
Analysis of the early efficacy of intra-articular injection of ropivacaine on postoperative analgesia on the first day after total knee arthroplasty
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摘要:
目的探讨全膝关节置换术后第一天关节内注射罗哌卡因对术后镇痛的早期疗效。 方法全膝关节置换术后80例病人随机分为2组。观察组:术后第一天拔除引流管后行关节内注射罗哌卡因。对照组术后第一天拔除引流管后不行关节内注射治疗。评估的内容包括术后疼痛视觉模拟评分(休息和运动状态)、手术后住院时间、术后初次下地时间、镇痛药物用量、切口并发症。 结果在休息时,术后连续5 d观察组的视觉模拟评分曲线下面积低于对照组(424±32 vs 515±39,t=11.41,P < 0.01)。术后第1天、2天观察组的各个时间点疼痛视觉模拟评分低于对照组(P < 0.05~P < 0.01)。观察组术后住院时间低于对照组,初次下地时间早于对照组(P < 0.01)。 结论全膝关节置换术后第一天关节内注射罗哌卡因可以对病人起到较好的镇痛效果,利于病人康复。 Abstract:ObjectiveTo explore the early effect of intra-articular injection of ropivacaine on postoperative analgesia on the first day after total knee replacement. MethodsEighty patients treated with total knee arthroplasty were randomly divided into the observation group and control group.The observation group and control group were treated with and without intra-articular injection of ropivacaine after the drainage tube was removed on the first day after operation, respectively.The postoperative pain visual simulation score(rest and exercise state), postoperative hospital stay, postoperative first time to the ground, analgesic drug dosage and incision complications were evaluated in two groups. ResultsAt rest, the area under the visual analogue score curve in observation group for 5 consecutive days after surgery was significantly lower than that in control group(424±32 vs 515±39, P < 0.01).The visual analogue scores of pain at various time points in observation group were significantly lower than those in control group on the first and second day after operation(P < 0.05 to P < 0.01).The length of hospital stay in observation group was significantly lower than that in control group(P < 0.01).The first landing time in observation group was significantly earlier than that in control group(P < 0.01). ConclusionsThe intra-articular injection of ropivacaine on the first day after total knee arthroplasty is a good analgesic effect on patients, and conducive to recovery. -
Key words:
- total knee arthroplasty /
- ropivacaine /
- postoperative analgesia
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表 1 2组术后休息状态不同时间点VAS评分比较(x±s)
分组 n 术后1 d 术后2 d 术后2 d 术后3 d 术后4 d 术后4 d 术后5 d 12:00 07:00 20:00 12:00 07:00 20:00 12:00 20:00 12:00 07:00 20:00 12:00 07:00 20:00 观察组 40 2.0±0.9 2.1±1.1 2.8±1.3 2.9±1.5 3.1±1.5 3.5±1.5 3.0±1.2 3.3±1.3 3.0±1.3 2.7±1.3 2.9±1.0 3.0±1.0 2.6±0.9 2.5±0.7 对照组 40 3.6±1.5 4.2±1.8 3.9±1.7 3.7±1.6 4.2±1.7 3.9±1.6 3.3±1.3 3.8±1.4 3.4±1.5 2.9±1.2 3.3±1.6 3.2±1.2 2.7±0.8 2.5±0.9 t — 5.78* 6.30* 3.25 2.31 3.07 1.15 1.07 1.66 1.27 0.72 1.34 0.81 0.43 0.34 P — < 0.01 < 0.01 < 0.01 < 0.05 < 0.01 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 *示t′值 表 2 2组术后运动状态不同时间点的VAS评分的比较(x±s)
分组 n 术后1 d 术后2 d 术后3 d 术后4 d 术后5 d 观察组 40 4.3±1.6 5.0±1.8 4.7±1.5 4.5±1.4 3.7±1.3 对照组 40 4.9±1.7 5.3±1.6 4.9±1.5 4.9±1.5 3.9±1.0 t — 1.63 0.79 0.59 1.19 0.77 P — > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 表 3 2组术后的住院时间、术后初次下地时间、镇痛药消耗量比较(x±s)
分组 n 术后住院时间/d 术后初次下地时间/d 非甾体类镇痛药消耗量/支 观察组 40 7.0±2.7 2.4±0.5 9.7±6.7 对照组 40 9.6±3.3 3.4±0.8 9.9±6.5 t — 3.86 6.70* 0.14 P — < 0.01 < 0.01 > 0.05 *示t′值 -
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