氨酚曲马多在人工膝关节围置换期镇痛的安全性

Safety of paracetamol and tramadol for perioperative analgesia of total knee arthroplasty

背景:中老年全膝关节置换患者身体功能较差,如在手术过程中缺乏理想的麻醉方法,可能导致患者预后较差,因此,有必要探索适用于人工膝关节置换的镇痛药物。目的:探讨氨酚曲马多在人工膝关节围置换期镇痛中的临床应用效果及其药物安全性。方法:从南京医科大学附属淮安第一医院骨科2013年12月至2015年1月收治的单侧人工全膝关节置换的患者中按随机数字表法选择200例进行研究,根据围置换期不同镇痛方法将患者分为对照组和实验组,每组100例,对照组采用静脉自控镇痛,实验组口服氨酚曲马多镇痛,分析氨酚曲马多在人工膝关节围置换期镇痛中的临床应用效果及其药物安全性。结果与结论:两组患者置换即刻、置换后第4,5天目测类比评分差异无显著性意义;实验组患者置换后第1-3天目测类比评分显著低于对照组。实验组患者置换后7 d和12个月时的HSS评分与置换后24,72 h的SS评分均显著高于对照组。实验组患者置换后24和48 h追加氨酚曲马多剂量以及2次总药量显著低于对照组。实验组患者并发症发生率显著低于对照组。提示在人工膝关节围置换期镇痛中采用氨酚曲马多效果理想,能够缓解患者疼痛,利于膝关节功能恢复,药物不良反应少,具有一定的临床应用价值。

BACKGROUND： The function was poor in middle aged and elderly patients with total knee replacement. If there was no ideal anesthesia during the operation, the prognosis of patients would be poor. Therefore, it is necessary to explore the analgesic drugs for artificial knee joint arthroplasty. OBJECTIVE： To investigate clinical analgesic efficacy of tramadol and paracetamol in total knee arthroplasty and the drug safety. METHODS： 200 cases undergoing unilateral total knee arthroplasty in the Department of Orthopedics of Huaian First Hospital Affiliated to Nanjing Medical University from December 2013 to January 2015 were enrolled in this study. According to the different methods of analgesia, patients were divided into control and experimental groups with 100 cases in each group. Control group received intravenous patient controlled analgesia. Experimental group received paracetamol and tramadol orally. Clinical analgesic efficacy and safety of tramadol paracetamol in total knee arthroplasty were analyzed. RESULTS AND CONCLUSION： No significant difference in visual analogue scale score was detected immediately,4 and 5 days after replacement in both groups. Visual analogue scale score was significantly lower in the experimental group than in the control group at 1-3 days after replacement. Hospital for Special Surgery scores at 7 and 12 months after replacement and Special Surgery scores at 24 and 72 hours after replacement were significantly higher in the experimental group than in the control group. The twice doses of tramadol and paracetamol were significantly lower at24 and 48 hours after replacement in the experimental group than in the control group. The incidence of complications was significantly lower in the experimental group than in the control group. These data verify that during perioperativeanalgesia, the effects of tramadol and paracetamol were ideal, could lessen patient＇s pain, contribute to the recovery of knee function, have less adverse reactions, and have a certain clinical application value.