多模式镇痛对人工全膝关节置换术患者功能锻炼的效果观察

摘要

Objective To study the effective of multimodal analgesia of the functional exercise for patients with total knee arthroplasty. Method 80 patients with total knee arthroplasty was selected from March 2010 to June 2010 for the study. Based on date of surgery, the patients was randomly divided into observation (multi-modal analgesia ) group and control group. There are two cases of patients without surgery and two patients diverted to other surgery in observation group. There were 36 cases included in the study. There was four cases without surgery and three cases to be diverted to other surgery in control group. The patients in observation group received preoperative cocktail injection Parry past Bouna 40 mg around the joint cavity and periarticular injection of ropivacaine hydrochloride l00mg around joint. Patients in control group were given postoperative conventional treatment of self-controlled epi-dural analgesia. The VAS scores, functional exercises (range of motion, straight leg raising, postoperative walking) and compliance for patients between the two group were observed and compared. Result There was significant different in peri-operative multimodal analgesia, resting pain VAS score, the postoperative limbs situation (range of motion, straight leg raising, postoperative ambulation) and compliance between observation and control group(iJ< 0.05). Conclusion Multimodal analgesia was played an important role in early recovery for total knee arthroplasty patients with functional exercise. It's not only improve the overall efficacy of post-operative, but also promote the re covery of knee function, increase the compliance of patients with postoperative functional exercise.%目的 研究多模式镇痛对人工全膝关节置换术患者功能锻炼的镇痛效果观察.方法 选择2010年3～6月期间80例行人工全膝关节置换术的患者,按手术日期随机分为观察组(多模式镇痛组)和对照组.观察组中,有2例患者未手术,有2例患者改行其他手术,共有36例纳入研究；对照组中有4例未手术,3例改行其他手术,因此,共有33例纳入研究.观察组患者术前给予关节腔周围鸡尾酒样注射帕瑞昔布钠40 mg以及关节周围注射盐酸罗哌卡因注射液100 mg;对照组给予常规治疗术后均接受硬膜外自控镇痛.比较两组患者的VAS评分、功能锻炼(关节活动度、直腿抬高、术后行走)和依从性情况.结果 观察组与对照组相比,差异有显著意义(P＜0.05).结论 多模式镇痛对人工全膝关节置换术患者功能锻炼的镇痛效果良好,不但能改善手术后的整体疗效,更能促进膝关节功能恢复,增加患者术后功能锻炼的依从性,对早日康复起着重要的作用.