多模式镇痛与静脉自控镇痛对类风湿关节炎全膝关节置换术围手术期镇痛效果的病例对照研究

摘要

目的:比较多模式镇痛与静脉自控镇痛对类风湿关节炎患者全膝关节置换围手术期的镇痛效果.方法:自2015年6月至2016年6月对40例类风湿关节炎患者行单侧全膝关节置换术治疗,分为2组.静脉自控镇痛组20例,男3例,女17例,平均年龄(59.6±2.3)岁;多模式镇痛组20例,男2例,女18例,平均年龄(56.3±1.3)岁.静脉自控镇痛组采用静脉镇痛泵控制性滴入舒芬太尼镇痛,多模式镇痛组采用连续股神经阻滞、膝关节局部注射及丁丙诺啡贴剂联合镇痛方案,比较两组患者全膝关节置换术后48 h内VAS评分及不良反应发生率,术后1周HSS评分,评价两种镇痛模式的优劣.结果:术后6、24h,多模式镇痛组患者VAS评分低于静脉自控镇痛组;术后48 h在运动和静止状态下,多模式镇痛组患者VAS评分均低于静脉自控镇痛组.术后1周多模式镇痛组HSS评分高于静脉自控镇痛组,HSS评分中的功能、疼痛及活动度评分,多模式镇痛组优于静脉自控镇痛组,但肌力评分两组差异无统计学意义.结论:多模式镇痛效果好,不良反应少,是类风湿关节炎患者全膝关节置换围手术期理想的镇痛方案.%Objective:To compare the analgesic effect between multimodal and patient-controlled intravenous analgesia (PCIA) in patients with rheumatoid arthritis (RA) in the perioperative period of knee joint replacement.Methods:From June 2015 to June 2016,40 RA patients undergoing total knee arthroplasty were randomly divided into two groups.There were 20 patients in PCIA group,including 3 males and 17 females,with an average age of(59.6±2.3) years old,who received controlled instillation of sufentanil analgesia controlled by an intravenous analgesia pump.There were 20 patients in multiple model analgesia group,including 2 males and 18 females,with an average age of (56.3± 1.3) years old,who were treated with continuous femoral nerve block,local injection of knee joint and combined buprenorphine patches.The VAS score and the incidence of adverse reactions and HSS score were compared between the two groups after operation.The advantages and disadvantages of the two modes of analgesia were evaluated.Results:On the 6 th and 24 th hours after surgery,the VAS scores of the multimodal analgesia group were significantly lower than those of the PCIA group(P＜0.01).On the 48 th hour after surgery,the VAS scores was significantly lower in the multimodal analgesia group than those in PCIA group (P＜0.000 1),both in the state of motion and at rest.On the 1 st week after surgery,the HSS score of the multimodal analgesia group was significantly higher than that in the PCIA group (P＜0.000 1).The pain score and the degree of activity in HSS score of the multimodal analgesia group were better than those in PCIA group (P＜0.05).The functional score of multimodal analgesia group was significantly better than that of PCIA group (P＜0.01).But there was no significant difference in muscle strength scores between two groups.Conclusion:Multimodal analgesia is an ideal analgesic plan for total knee arthroplasty TKA patients with RA in perioperative period,which has good effects and little adverse reaction.