背景:心理因素影响全膝关节置换后患者疼痛程度,干预围手术期心理状态对置换后疼痛以及关节功能的影响尚未见大量报道.目的:观察阿普唑仑干预全膝关节置换前具有焦虑抑郁状态患者的安全性和有效性.方法:选择61例单侧全膝关节置换前存在焦虑抑郁状态的患者,随机分为2组,术前2周干预组予以阿普唑仑片,对照组予以安慰剂.收集基线资料、手术相关资料,术前汉密尔顿评分和Beck抑郁量表评估焦虑抑郁状态变化,术后评估2组患者各时间点静息和活动时的疼痛评分,统计术后非类固醇镇痛药物和静脉自控镇痛泵使用情况,ELISA法检测外周血神经递质,利用相关量表评估关节置换后近中期关节功能,统计患者满意度和住院相关指标,检测药物不良反应.结果与结论:①应用阿普唑仑后干预组焦虑抑郁状态有显著改善;干预后2周干预组外周血5-羟色胺和γ-氨基丁酸水平上升;②术后12h、1d、2d、3d、5d、7d时干预组静息疼痛目测类比评分显著低于对照组(P<0.05);术后12 h、1 d、2 d、3 d、5 d时干预组运动疼痛目测类比评分显著低于对照组(P<0.05);③干预组镇痛泵及镇痛药物使用均显著少于对照组,镇痛药物使用剂量与术前焦虑抑郁状态具有相关性;④2组术后西安大略-麦克马斯特大学骨关节炎指数和美国膝关节协会评分差异无显著性意义;⑤全膝关节置换后干预组满意度、睡眠指数、住院总时长等指标优于对照组.用药期间未见明显不良反应;⑥结果提示,对于全膝关节置换前诊断为焦虑抑郁状态的患者,置换前予以阿普唑仑干预可以缓解焦虑抑郁,改善围手术期静息和运动疼痛,减少术后镇痛药物的使用,增加患者满意度.%BACKGROUND:Psychological factors could influence the degree of pain after total knee arthroplasty. However, the effects of perioperative psychological intervention on postoperative pain and joint function are rarely reported. OBJECTIVE:To study the efficacy and safety of alprazolam for patients with anxiety and depression before total knee arthroplasty. METHODS:Sixty-one patients with anxiety and depression before unilateral total knee arthroplasty were recruited. The patients were given the treatment of alprazolam (experimental group) or placebo (control group) at 2 weeks preoperatively. Baseline data were collected, preoperative anxiety and depression were assessed with Hamilton Anxiety Scale and Beck Depression Inventory, perioperative pain at rest and in activity at each time point was evaluated, postoperative NSAIDs drugs and intravenous self-control analgesia pump usage were recorded, the peripheral neurotransmitters were detected by ELISA, short-and mediate-term joint fuction was evaluated through Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score after joint replacement, patient satisfaction and in-hospital relevant indexes and adverse reactions were detected. RESULTS AND CONCLUSION:(1) After the application of alprazolam, anxiety and depression were improved notablely, and the levels of 5-hydroxytryptamine andγ-aminobutyric acid in peripheral blood were increased at 2 weeks. (2) The visual analogue scale scores at rest in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, 5 and 7 days postoperatively (P<0.05);the visual analogue scale scores in activity in the experiemntal group were significnatly lower than those in the control group at 12 hours, 1, 2, 3, and 5 days postoperatively (P<0.05). (3) Analgesia pump and analgesic drug usage in the experiemntal group were significantly less than those in the control group, and the analgesic drug dosage and preoperative anxiety depression were correlated. (4) There were no significant differences in the Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score between two groups. (5) The patient satisfaction, sleep index and hospitation time in the experimental group were superior to those in the control group. No obvious adverse reactions occurred during medication. (6) Our results suggest that for patients diagnosised with anxiety and depression before total knee replacement, the preoperative application of alprazolam can alleviate anxiety and depression, improve perioperative pain at rest and in activity, reduce postoperative analgesia drug useage, and increase patient satisfaction.
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