疼痛控制对人工全膝关节置换术后患者早期康复效果的影响

Effect of pain control on the early rehabilitation of patients after total knee arthroplasty

目的观察不同镇痛方法对人工全膝关节置换术后患者早期康复效果的影响。方法选择84例行单侧人工全膝关节置换的患者,随机分为2组。观察组采用多模式镇痛方法,对照组术后应用硬膜外自控镇痛泵。两组术后均进行康复锻炼。观察两组患者术后不同时间点的疼痛程度、康复计划的完成情况、膝关节功能恢复情况及患者对于康复情况的满意度。结果两组比较,观察组术后各时间点静息状态的疼痛视觉模拟评分及术后24h、48h、72h膝关节活动时的疼痛视觉模拟评分均低于对照组,差异有统计学意义(P<0.01)。观察组术后24h、48h、72h、1周、2周、4周膝关节的活动度明显高于对照组(P<0.01)。观察组术后4周康复方案的完成情况显著优于对照组(P<0.05),患者对于康复效果的满意度显著高于对照组(P<0.05)。结论多模式镇痛方法应用于人工全膝关节置换围术期疼痛的镇痛效果满意,能够促进术后康复计划的顺利实施。

Objective To evaluate the effects of multimodal analgesia and patient control analgesia on the early rehabilitation of patients after total knee arthroplasty. Methods Eighty-four patients after total knee arthroplasty were randomly divided into two groups. Patient controlled analgesia and multimodal analgesia were provided for the patients in the control group and experimental group,respectively. All the patients performed postoperative functional exercises. The postoperative pain rated by visual analog scales （VAS） at different time-polnts,the completion of the rehabilitation plan,the function of the knee and patient satisfaction were compared between the two groups. Results The VAS scores for postoperative pain at rest at 2h,4h, 6h,8h,10h,12h,18h,24h after the operation,and pain during passive activity at 24h,48h,72h after the operation were all significantly lower in experimental group than those of control group （P〈0.01）. The range of motion of knee joint at 24h,48h, 72h, lw,2w,4w after the operation was higher in the experimental group than those of control group（P〈0.01）. The completion of the rehabilitation plan was better and patient satisfaction was higher in the experimental group than that of control group （P〈0.05）. Conclusion The muhimodal analgesia is more effective than routine analgesia method in the control of postoperative pain after total knee arthroplasty. Moreover,it can promote the completion of postoperative rehabilitation plan.