中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (27): 4265-4270.doi: 10.3969/j.issn.2095-4344.0338

• 人工假体 artificial prosthesis •    下一篇

全膝关节置换多模式镇痛:吗啡与鸡尾酒镇痛的疗效对比

李国庆,王添兴,莫和塔尔•莫敏,马 骏,汪 洋   

  1. 新疆医科大学第一附属医院关节外科,新疆维吾尔自治区乌鲁木齐市   830000
  • 出版日期:2018-09-28 发布日期:2018-09-28
  • 通讯作者: 汪洋,主治医师,新疆医科大学第一附属医院关节外科,新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:李国庆,男,1969年生,新疆维吾尔自治区霍城县人,锡伯族,2003年新疆医科大学毕业,硕士,副主任医师,主要从事骨与关节损伤方面的研究。
  • 基金资助:

     国家自然科学基金(81760398)

Multimodal analgesia of total knee arthroplasty: analgesic effect of morphine versus cocktail  

Li Guo-qing, Wang Tian-xing, Mohetaer•Momin, Ma Jun, Wang Yang   

  1. Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Online:2018-09-28 Published:2018-09-28
  • Contact: Wang Yang, Attending physician, Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Li Guo-qing, Master, Associate chief physician, Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81760398

摘要:

文章快速阅读:

 
 

 

文题释义:
全膝关节置换:是按照正常的膝关节解剖切除已经磨损破坏并且无法自我修复的膝关节面,由人工关节部件代替病损部位,纠正关节力线,恢复膝关节功能,是治疗晚期膝关节病变的有效方法。
多模式镇痛:是指利用添加剂或多种不同种类药物的相互协同作用,不仅可以有效缓解疼痛,同时可避免对一种药物产生依赖,降低因药物大剂量产生不良反应的可能性。
 
摘要
背景:多模式镇痛是指利用添加剂或多种不同种类药物的相互协同作用,不仅可以有效缓解疼痛,同时可避免对一种药物产生依赖,降低因药物大剂量产生不良反应的可能性。
目的:对比分析全膝关节置换多模式镇痛中给予吗啡及鸡尾酒注射的镇痛效果。
方法:纳入初次单侧膝关节置换的骨关节炎患者148例,根据镇痛方案分为3组,A组50例,硬膜外麻醉置管拔出前硬膜外推注吗啡3 mg;B组46例硬膜外麻醉置管拔出前硬膜外推注吗啡3 mg+局部膝关节周围注射鸡尾酒;C组52例硬膜外注射等量生理盐水+局部膝关节周围注射鸡尾酒。3组患者术前均有骨关节炎及活动受限症状。比较各组术后目测类比评分、肌力、恶心呕吐、瘙痒及首次排尿时间。
结果与结论:①3组术后静息、运动时目测类比评分比较,6,12 h C组评分高于A、B组,差异有显著性意义(P < 0.05),其中A组与B组行q检验,差异无显著性意义(P > 0.05);3组24,36 h差异无显著性意义(P > 0.05);3组术后地佐辛使用率差异无显著性意义(P > 0.05);②3组术后肌力比较,6,12 h C组肌力高于A、B组,差异有显著性意义(P < 0.05),其中A组与B组行q检验,差异无显著性意义(P > 0.05);③3组术后尿潴留、恶心呕吐、瘙痒发生情况比较差异有显著性意义(P < 0.05),C组并发症发生率少于A、B组,其中A组与B组比较差异无显著性意义(P > 0.05);④提示全膝关节置换多模式镇痛中,硬膜外麻醉不联合给予吗啡加局部注射鸡尾酒可明显改善早期患者肌力,且尿潴留、恶心呕吐、瘙痒等并发症明显下降。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0001-5645-6726(李国庆)

关键词: 全膝关节置换, 硬膜外麻醉, 镇痛, 吗啡, 国家自然科学基金

Abstract:

BACKGROUND: Multimodal analgesia effectively alleviates pain by additives and synergistic effect various drugs. It can avoid drug dependence and reduce adverse reactions caused by drug overdose.

OBJECTIVE: To analyze the analgesic effect of morphine versus cocktail in multimodal analgesia of total knee arthroplasty (TKA).
METHODS: Totally 148 patients undergoing primary unilateral TKA were enrolled. The patients were assigned by analgesic modes: group A (n=50) received the epidural injection of 3 mg of morphine before epidural tube removed; group B (n=46) was given the epidural injection of 3 mg of morphine and local injection of cocktail surrounding the knee joint before epidural tube removed; group C (n=52), received the epidural injection of same volume of normal saline and local injection of cocktail surrounding the knee joint. The patients in each group had the osteoarthritis and limited range of movement preoperatively. The postoperative Visual Analogue Scale score, muscle strength, nausea, vomiting, pruritus, and the first urination time were compared among groups.
RESULTS AND CONCLUSION: (1) The postoperative Visual Analogue Scale scores at rest and in activity in the group C were significantly higher than those in the groups A and B at 6 and 12 hours (P < 0.05). The q test results showed that the scores showed no significant differences between groups B and C (P > 0.05). The scores at 24 and 36 hours did not differ significantly among groups (P > 0.05). The administration rate of dezocine showed no significant difference among groups (P > 0.05). (2) The muscle strength at postoperative 6 and 12 hours in the group C was significantly higher than that in the groups A and B (P < 0.05), and no significant difference was found between groups A and B through q test (P > 0.05). (3) The incidences of urinary retention, nausea, vomiting and pruritus in the group C were significantly less than those in the groups A and B (P < 0.05), and there was no significant difference between groups A and B (P > 0.05). (4) In summary, in multimodal analgesia of TKA, epidural anesthesia of local injection of cocktail without morphine can significantly improve the early muscle strength, and reduce the complications of urinary retention, nausea, vomiting and pruritus.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Knee, Anesthesia, Epidural, Analgesia, Morphine, Tissue Engineering

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