中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (31): 4945-4950.doi: 10.3969/j.issn.2095-4344.2017.31.005

• 人工假体 artificial prosthesis • 上一篇    下一篇

两种镇痛方法对全膝关节置换围置换期应激反应及血管活性物质的影响

李 媛,谢 海,周 期,张 娇   

  1. 海南医学院第一附属医院麻醉科,海南省海口市 570102
  • 出版日期:2017-11-08 发布日期:2017-12-01
  • 通讯作者: 谢海,硕士,副主任医师,海南医学院第一附属医院麻醉科,海南省海口市 570102
  • 作者简介:李媛,女,1980年生,山东省人,汉族,2010年哈尔滨医科大学毕业,硕士,副主任医师,主要从事麻醉、疼痛及相关基础研究。
  • 基金资助:

    海南省自然科学基金项目(813189):炎症因子调节围手术期老年病人血糖代谢对术后认知功能的影响

Effects of two analgesia methods on the stress response and hemodynamics during total knee arthroplasty

Li Yuan, Xie Hai, Zhou Qi, Zhang Jiao   

  1. Department of Anesthesiology, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
  • Online:2017-11-08 Published:2017-12-01
  • Contact: Xie Hai, Master, Associate chief physician, Department of Anesthesiology, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
  • About author:Li Yuan, Master, Associate chief physician, Department of Anesthesiology, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
  • Supported by:

    the Natural Science Foundation of Hainan Province, No. 813189

摘要:

文章快速阅读:



文题释义:
全膝关节置换后疼痛:从血流动力学上分析,疼痛就其生物学意义来讲是一种警戒信号,也是由于神经系统的调节引起一系列防御反应。全膝关节置换术后产生的炎症因子能够作用于局部肥大细胞和血小板,进行化学介质的释放,对痛觉神经终末感受器产生作用,从而患者感觉到疼痛。
股神经阻滞自控镇痛:用于术后镇痛的优势明显,外周神经阻滞镇痛越来越得到重视,尤其对于心肺功能差的老年患者具有重要意义。股神经阻滞自控镇痛可以干扰多个层面的痛觉感知,产生不同药物和镇痛方式的共同作用。
 
摘要
背景:对全膝关节置换患者疼痛的处理一直是临床治疗中关注的重点,寻找安全有效的镇痛方法是外科医生临床研究及工作的重要任务。
目的:对比股神经阻滞自控镇痛与自控硬膜外镇痛对全膝关节置换患者围术期应激反应及血流动力学的影响。
方法:选择2012年8月到2016年1月在海南医学院第一附属医院进行单侧全膝关节置换的患者60例,根据入院顺序分为观察组与对照组,每组30例。全膝关节置换手术由同一组高年资医生完成,均采用标准的全膝关节置换,对照组采用自控硬膜外镇痛,观察组采用股神经阻滞自控镇痛。观察2组预后、围置换期应激反应及血管活性物质变化情况。
结果与结论:①观察组术后4,24,48 h的应激目测类比评分均显著低于对照组(P < 0.05);②观察组术后24,48 h血清5-羟色胺质量浓度均显著低于对照组(P < 0.05);③2组术前患肢美国膝关节协会评分差异无显著性意义,术后均呈现明显增加的趋势(P < 0.05),同时观察组术后1,3个月的美国膝关节协会评分显著高于对照组(P < 0.05);④观察组术后3个月的呼吸抑制、尿潴留、肺不张、皮肤瘙痒、恶心呕吐等并发症发生情况明显少于对照组(P < 0.05);⑤结果提示,相对于自控硬膜外镇痛,股神经阻滞自控镇痛应用于全膝关节置换围手术期能缓解应激疼痛反应,降低5-羟色胺的表达,减少并发症的发生,从而促进患者关节功能的恢复。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-0906-1219(李媛)

关键词: 骨科植入物, 人工假体, 全膝关节置换, 应激反应, 血管活性物质, 股神经阻滞自控镇痛, 自控硬膜外镇痛, 海南省自然科学基金

Abstract:

BACKGROUND: Pain relief in patients with total knee arthroplasty has always been an important problem, and searching for a safe and effective analgesic method is an issue of concern.

OBJECTIVE: To compare the effects of patient controlled nerve femoral analgesia and patient controlled epidural analgesia on the perioperative stress response and hemodynamics in patients with total knee arthroplasty.
METHODS: Sixty patients undergoing unilateral total knee arthroplasty admitted in the First Affiliated Hospital of Hainan Medical University from August 2012 to January 2016 were selected and equally divided into observation and control groups according to the order of admission. The total knee arthroplasty was completed by the senior doctors using operation criteria. The patient controlled epidural analgesia analgesia was used in the control group, while the observation group received the patient controlled nerve femoral analgesia analgesia. The prognosis, perioperative stress response and hemodynamic changes were observed.
RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores at postoperative 4, 24 and 48 hours in the observation group were significantly lower than those in the control group (P < 0.05). (2) The serum level of 5-hydroxytryptamine at postoperative 24 and 48 hours in the observation group was significantly lower than that in the control group (P < 0.05). (3) The American Knee Society Knee Score scores at baseline showed no significant difference between two groups, and then appeared to be on a significant rise postoperatively (P < 0.05), while the scores at postoperative 1 and 3 months in the observation group were significantly higher than those in the control group (P < 0.05). (4) The incidence of respiratory depression, urinary retention, atelectasis, skin itching, nausea and vomiting at postoperative 3 months in the observation group was significantly less than that in the control group (P < 0.05). (5) These results manifest that compared with the patient controlled epidural analgesia, the patient controlled nerve femoral analgesia in total knee arthroplasty can alleviate the stress response to pain and reduce the expression of 5-hydroxytryptamine and the incidence of complications, further promoting the recovery of joint function.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Knee, Prosthesis Implantation, Femoral Nerve, Analgesia, Epidural, Tissue Engineering

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