术前静脉采血穿刺疼痛评估预测全膝关节置换术后疼痛程度的价值

Preoperative puncture pain assessment to predict the degree of pain after total knee arthroplasty

背景:人工全膝关节置换术(TKA)是目前治疗各种终末期膝关节疾病最有效的办法,围手术期疼痛管理至关重要,直接影响到术后功能康复。目的:通过进行术前穿刺疼痛评估分组,预测TKA术后的疼痛程度,为精准化TKA围手术期镇痛方案提供参考。方法:选择2019年10月至2020年1月行TKA手术的94例患者,根据术前采血时穿刺的疼痛视觉模拟评分(VAS)进行分组。分别记录各组患者术后2~4 h、术后1 d、术后2 d、术后3 d各时间点的运动痛及静息痛VAS评分。结果:术前穿刺VAS评分越高的患者,术后TKA的急性期各时间点的静息痛及运动痛的VAS评分越高。术前穿刺3分的患者术后各时间点疼痛VAS评分均高于术前穿刺0分及1分的患者,且差异均有统计学意义(P均<0.05)。结论:行TKA手术的患者,术前评估穿刺实验VAS评分,可一定程度预测术后TKA疼痛程度。

Background:Total knee arthroplasty(TKA)is currently the most effective way to treat various end-stage knee diseases.Perioperative pain management of TKA is critical and directly affects postoperative functional rehabilitation.Objective:To predict the pain level after TKA by conducting a preoperative puncture pain assessment,and to develop a personalized perioperative analgesia plan.Methods:A total of 94 patients who underwent TKA in Beijing Union Medical College Hospital from October 2019 to January 2020 were enrolled in this study.They were divided into different groups according to preoperative VAS score during blood collection.The VAS scores of exercise pain and rest pain of the knee were recorded at 2-4 h,day 1,day 2,and day 3 days after operation in each group.Results:The higher VAS score of preoperative puncture for blood collection,the higher VAS scores of rest pain and exercise pain at various time points during the acute phase of TKA after surgery.The VAS scores at each time point after surgery in patients with 3 points of VAS score of preoperative puncture experiment were significantly higher than those in patients with zero and one point of preoperative VAS score(P<0.05).Conclusions:For patients undergoing TKA,the VAS score of the puncture test before surgery can predict the degree of postoperative TKA pain to some extent.