氨酚羟考酮片对全膝置换术后患者的镇痛效果临床观察

Analgesic efficacy of oxycodone-acetaminophen tablets after total knee arthroplasty

目的:观察口服氨酚羟考酮片用于全膝关节置换术后康复镇痛的效果。方法:选择行单侧全膝关节置换患者50例,随机分为氨酚羟考酮组(T组,n=25)和塞来昔布组(S组,n=25),氨酚羟考酮组患者术后口服氨酚羟考酮片(商品名泰勒宁,1片,tid)镇痛,塞来昔布组患者术后口服塞来昔布胶囊(商品名西乐葆,200 mg,bid)镇痛;两组患者均维持镇痛5 d。术后记录静息(RVAS)、主动(IVAS)和持续被动(PVAS)功能训练时的VAS疼痛评分,以及患者术后的主动直腿抬高时间、主动屈膝90°时间和相关并发症发生情况。结果:氨酚羟考酮组患者在术后24,48及72 h的RVAS评分、功能训练时的IVAS评分和PVAS评分均明显低于塞来昔布组(P<0.01);而两组患者于术后96和120 h的RVAS评分、功能训练时的IVAS评分和PVAS评分无显著性统计学差异。氨酚羟考酮组患者术后的主动直腿抬高时间、主动屈膝90°时间均显著短于塞来昔布组(P<0.01)。出院时氨酚羟考酮组患者的平均膝关节活动度显著大于塞来昔布组(P<0.01)。氨酚羟考酮组出现3例不良反应。结论:氨酚羟考酮用于全膝关节置换术后康复镇痛效果良好,能促进早期功能康复,提高患者对手术的满意度,且并发症发生率低,是全膝关节置换术后较为理想的镇痛方法。

Objective：To observe the analgesic efficacy of oxycodone-acetaminophen tablets after total knee arthroplasty（TKA）.Methods： Fifty patients undergoing unilateral TKA surgery were randomly divided into two groups.The patients took oxycodone-acetaminophen tablets（Tylox,1 tablet,tid,group T,n=25） or celecoxib capsules（Celebrox,200 mg,bid,group S,n=25） after TKA.Analgesic treatment maintained for 5 days in all patients.The following indicators were recorded： VAS pain scores during rest（RVAS）,initiative exercise（IVAS） and continuous passive movement（PVAS）,the range of genuflex movement（ROM） to arrive 90 degrees,and complications.Results： The VAS pain scores during rest,initiative exercise and CPM on the postoperative time of 24,48 and 72 h were significantly lower in group T than in group S（P0.01）.However,there was no significance in the postoperative time of 96 and 120 h between the two groups.The time for the range of genuflex movement（ROM） to arrive 90 degrees was significantly shorter in group T than in group S（P0.01）.The mean knee ROM was obviously larger in group T than in group S（P0.01）.There were no significant differences in complications between the two groups.Conclusion： After TKA surgery,oxycodone-acetaminophen tablets can provide better pain relief,and fewer side effects.It may be the choice for postoperative analgesia.