个体化镇痛方案对双膝关节置换术后疼痛的疗效观察

摘要

目的 观察个体化镇痛方案对双膝关节置换术后疼痛的效果.方法2012年1月至2016年12月我科收治的双膝关节置换手术病人122例,通过随机数字表法随机分为研究组(58例)和对照组(64例),对照组在双膝关节置换术后采用传统疼痛护理,研究组在双膝关节置换术后采用个体化镇痛方案.比较两组病人入院时、术后的静息状态、深呼吸等状态下的疼痛数字评分量表(numerical rating scale,NRS)评分,以及术后第1、7、14天和出院3个月时的美国膝关节协会(the American Knee Society, AKS)综合评分.结果 研究组58例病人入院时、术后的静息状态、深呼吸、说话时、咳嗽时、下地行走时、直立自身负重时、正常关节活动角度时、睡眠时的NRS评分分别为(1.8±0.7)分、(0.8±0.3)分、(1.2± 0.4)分、(1.2±0.4)分、(1.8±0.5)分、(2.2±0.7)分、(2.4±0.6)分、(2.5±0.8)分、(0.7±0.2)分,术后第1、7、14天和出院3个月时的AKS评分总分分别为(40.39±5.52)分、(83.37±5.64)分、(118.61±10.33)分、(190.21± 10.29)分,均显著优于对照组,差异均有统计学意义(P均<0.05).结论 个体化镇痛方案能有效减轻病人疼痛,促进膝关节功能快速康复,有利于无痛病房的建立.%Objective To observe the effects of individualized analgesic solution on postoperative pain after bilateral knee replacement. Methods A total 122 patients with postoperative bilateral keen replacement were divided into treatment group(58 cases)and control group(64 cases)after randomly sampling. Traditional pain management was given to patients in the treatment group after bilateral knee replacement while the individualized analgesic solution was given to patients in the control group after bilateral knee replacement. The numerical rating scale(NRS)scores were compared between the two groups of patients at admission,resting state,deep breathing,and so on.The United States the American Knee Society(AKS)score was scored at 1st, 7th,14th days after surgery and 3 months after discharge.Results The NRS scores in experimental group of 58 patients were 1.8±0.7,0.8±0.3,1.2±0.4,1.2±0.4,1.8±0.5,2.2±0.7,2.4±0.6,2.5±0.8,0.7±0.2.The total score of AKS at 1st,7th,14th days and 3 months after discharge was 40.39±5.52,83.37±5.64,118.61±10.33, and 190.21±10.29.All of them were significantly better than those in the control group,and the difference was statistically significant (P<0.05 for all). Conclusion The individualized analgesic solution can effectively reduce patient's pain and promote the fast recovery of knee function.It is better to set up a painless ward.