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关节内置管局部浸润镇痛在全膝关节置换术的应用>>lunwen.5151doc

关节内置管局部浸润镇痛在全膝关节置换术的应用
作者:曾金才 … 文章来源:论文资源库 点击数: 更新时间:2010-4-29

  论文《关节内置管局部浸润镇痛在全膝关节置换术的应用》由论文资源库lunwen.5151doc.com收集整理,版权归原作者所有,大家可以进行参考,但不要抄袭。

  作者:曾金才 孙俊英 杨立文 王勇 魏立 刘宏鸣

  【摘要】  [目的]观察使用关节内置管局部浸润镇痛对全膝关节置换术后镇痛的早期临床疗效。[方法]收集从2008年12月~2009年4月在本院行全膝关节置换术后采用置管镇痛者11例(12膝)。其中男3例,女8例,单侧手术者10例,同期双侧手术者1例。术前诊断:退变性骨关节炎8例,类风湿性关节炎2例,创伤后关节炎1例。所有患者围手术期镇痛方案均统一,术中关节周围注射“鸡尾酒”镇痛药液,并关节内置管术后1 d单次追加推注镇痛药液。记录患者术后1~3 d疼痛VAS评分、总体满意度、膝关节活动度、主动直腿抬高时间及伤口并发症等。[结果]所有患者均未使用胃肠外阿片类药物,术后1~3 d休息痛和运动痛VAS评分均获得显着改善,主动直腿抬高时间平均为2.6 d,手术后第2 d和第3 d的膝关节平均主动活动度各为41°和55°,患者总体满意度高,无明显并发症。[结论]全膝关节置换术后经关节内置管多模式局部浸润镇痛,能显着延长术后镇痛时间,降低手术24 h以后的休息痛、运动痛以及VAS评分,促进关节早日锻炼,提高患者满意度,且简单、实用、安全、有效。

  【关键词】  全膝关节置换术 局部浸润镇痛 关节内 置管 多模式镇痛

  Abstract: [Objective]To observe the postoperative early efficacy of  intraarticular catheter local anesthetic infiltration analgesia following total knee arthroplasty. [Methods]From December 2008 to April 2009, eleven patients (twelve knees) undergoing total knee arthroplasty were received this analgesia protocol, including 3 men and 8 women, all of them were performed unilateral total knee arthroplasty, except for 1 bilateral for RA patient.Preoperative diagnosis included 8 osteoarthritis patients, 2 rheumatoid arthritis, 1 posttraumatic arthritis.They were selected the same perioperative multimodal analgesia protocol, reveiving one intraoperative periarticuiar injection multimodal drugs fluid “cocktail wine”, combined with one postoperative 1 day single-shot intraarticular injection of the same substances through an intraarticular catheter.Visual analog scores for pain at some time point up to 3 days postoperatively,total satisfaction score, the range of motion of knee joint, time of active straight leg raising and wound complications were collected.[Results]All the patients did not use parenteral opioids,the overall VAS pain score during rest and exercise for 1~3 days postoperatively was low.Time of active straight leg raising were 2.6 days postoperatively in average. During the 2nd and 3rd days postoperatively, the average knee joint activity were 41°and 55°,the total satisfactory  score of patients was high, no other apparent complications was found.[Conclusion]A  multimodal local infiltration analgesia technique using intraarticular catheter following total knee arthroplasty  can significantly prolong the postoperative analgesia, reduce pain during rest and activities and the VAS score after 24h  postoperatively, promote joint training at an early date, improve patient's satisfaction, and it is simple, practical, safe and effective.

  Key  words:total knee arthroplasty;  local infiltration analgesia;  intraarticular;  catheter;  multimodal analgesia

  虽然全膝关节置换术(total knee arthroplasty,TKA)是治疗各类膝关节终极疾病的有效方法,然而术后疼痛仍然是困扰这一手术的主要难题,据统计严重和中度疼痛率分别高达60%和30%。严重疼痛不但直接延长了患者的住院时间,增加了医疗费用,还对膝关节功能康复构成直接影响。

  缓解TKA术后痛的传统方法是硬膜外麻醉或连续外周神经阻滞,缺点是技术要求高,潜在副作用如恶心、呕吐、尿潴留、脊髓性头痛和运动恢复迟缓等发生率高[1]。近年来临床应用较多的方法是在TKA手术结束前,行关节内多种镇痛药液注射,以获得局部浸润镇

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