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多模式联合镇痛在人工关节置换围手术期的疗效观察
Efficacy of multiple mode of combination analgesia in treatment for perioperative pain of the artificial joint arthroplasty
  
DOI:
中文关键词:  全髋关节置换术  全膝关节置换术  镇痛  围手术期
英文关键词:Total hip arthroplasty  Total knee arthroplasty  Analgesia  Perioperative
基金项目:
作者单位
王国强 陈军 杨美英 马斌 吴西津 乔绍文 曹念蒙 包头市第四医院骨3科内蒙古 包头 01403 
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中文摘要:
      [摘要]目的 探讨多模式联合镇痛应用于人工关节置换术后的效果。方法 选取2011年1月~2013年12月行单侧全髋(THA)、全膝关节置换(TKA)病例138例,年龄53~79岁,平均68.4岁。手术及麻醉均由同一组医生完成。根据镇痛方式分为三组:术后自控静脉镇痛泵组(PCIA,对照组);术后自控静脉镇痛泵+塞来昔布口服组(塞来昔布组);术后自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组(罗哌卡因组)。比较术后各组6小时(T1)、12小时(T2)、24小时(T3)、48小时(T4)疼痛视觉模拟评分(VSA)、药物不良反应、病人满意程度、自控追加剂量(Bolus)次数、自控静脉镇痛药用量。结果 术后各组T1、T2、T3、T4时间节段点的疼痛VSA评分均无统计学意义。与对照组比较,塞来昔布组和罗哌卡因组药物不良反应减少,镇痛满意度显著升高见(P值均<0.05),Bolus次数、舒芬太尼用量显著减少(P值均<0.05)。与塞来昔布组比较,罗哌卡因组恶心呕吐、尿潴留的发生率显著降低,镇痛满意度显著升高(P值均<0.05),不同时间节段点Bolus次数、舒芬太尼用量显著减少(P值均<0.05)。结论 自控静脉镇痛泵+塞来昔布口服+罗哌卡因局麻组成的多模式联合镇痛方法有助于降低阿片类镇痛药物用量,减少副作用,提高患者满意度,在人工关节置换术后镇痛疗效确切。
英文摘要:
      [Abstract] Objective To evaluate the analgesia effect of combination analgesia in patients with the artificial joint arthroplasty.Methods 138 patients were treated with unilateral total hip arthroplasty(THA) or total knee arthroplasty(TKA)in our hospital from January 2011 to December 2013, including males and females with an average of 68.4 years (rang,53 to 79),it had been finished by the same doctors and operation.All patients were randomly divided into three groups:Patient-controlled intravenous analgesia(PCIA,control group);PCIA+celecoxib(celecoxib group); PCIA+celecoxib+ropivacaine(ropivacaine group).Visual analogue scale(VSA), side effects, satisfaction, self-control additional dosage(bolus)and dosage of sufentanil of patients were observed in 6h(T1)、12h(T2)、24h(T3)、48h(T4)after THA or TKA.Results Among three groups ,the results of analgesia were no significant difference in T1、T2、T3、T4.Compared with control group, celecoxib group and ropivacaine group had less side effects(P<0.05), better degree of satisfaction(P<0.05), less bolus and dosage of sufentanil of patients(P<0.05). Compared with celecoxib group, ropivacaine group had less side effects(P<0.05), better degree of satisfaction(P<0.05), less bolus and dosage of sufentanil of patients(P<0.05).Conclusion Multiple mode of combination analgesia that were comprised of PCIA+celecoxib+ropivacaine is good at reducing dosage of sufentanil and side effects,improving degree of satisfaction in the artificial joint arthroplasty.
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