多模式镇痛治疗老年膝关节骨关节炎的临床研究

Clinical analysis of multi-mode analgesia treatment of older knee osteoarthritis

目的:根据多模式镇痛原理选择双氯芬酸凝胶联合双氯芬酸钠片治疗老年膝关节骨关节炎,观察并评估其近期临床疗效。方法:2010年1～6月门诊诊治的120例老年膝关节骨关节炎患者,随机分为治疗组(双氯芬酸钠片+双氯芬酸凝胶)和对照组(双氯芬酸钠片)。治疗组60例,给予双氯芬酸钠片25mg/次,Tid,口服+扶他林乳胶1～2g/次,日3次,共2周;对照组60例,给予双氯芬酸钠片25mg/次,Tid,口服,共2周。选择膝关节疼痛VAS评分、WOMAC评分标准(部分)及不良事件发生率作为疗效评价标准。分别记录两组治疗7、14d膝关节VAS评分、WOMAC评分标准及不良事件发生率,统计分析并进行术前术后及组间比较。结果:治疗后7、14d,疼痛VAS评分:治疗组分别为(3.2±1.0)、(2.1±0.8)分,对照组分别为(3.5±1.5)、(2.5±1.3)分;WOMAC评分:治疗组分别为(40±8)、(42±13)分,对照组分别为(33±10)、(30±12)分;治疗后14d不良事件发生率治疗组为48%(24/50例次),对照组为71%(39/55例次)。统计学分析,治疗组、对照组分别与术前进行组内比较,术后7、14d内与术前比较在VAS评分、WOMAC评分及不良事件发生率均差异有统计学意义(P<0.05)。治疗组与对照组在术后7、14d行组间比较,在VAS评分、WOMAC评分及不良事件发生率均具有显著差异。结论:双氯芬酸凝胶联合双氯芬酸钠片行多模式镇痛可显著改善膝关节骨关节炎症状及治疗效果,降低不良事件发生率,提高患者整体评价,为老年膝关节骨关节炎门诊治疗提供了一种选择。

Objective：To evaluate the efficacy and safety of multimodal analgesia management of eldly osteoarthritis of knee joint.Methods：From January to June 2010 outpatient service of diagnosis and treatment in an elderly 120 knee osteoarthritis patients were randomly divided into the treatment group（double chlorine acid sodium ＋double chlorine acid gel） and the control group（double chlorine acid sodium）.The treatment group of 60 cases,gave double chlorine acid sodium 25 mg/time,Tid,oral＋ votalin emulgel 1-2 g/time,day three times for 2 weeks;In the control group to 60 cases,double chlorine acid sodium 25 mg/time,Tid,oral for 2 weeks.Chose knee pain score,WOMAC VAS assessment standards（part） and adverse event rates as curative effect evaluation standard.The two groups were record treatment 7,14 d knee VAS score,WOMAC scoring standards and incidence of aderse eents,statistical analyzed and preoperatived and postoperatived comparison between groups.Results：After treatment 7,14 d,pain VAS score：The treatment group were（3.2±1.0）,（2.1±0.8） points,respectively,and the control group were（3.5±1.5）,（2.5±1.3） points;WOMAC score：treatment group were（40±8）,（42±13） points,respectively,and the control group were（33±10）,（30±12） points;After treatment,the incidence of aderse eents 14 d treatment group was 48%（24/50 cases in control group times for 71%（39/55 cases times）.Statistical analyzed,the treatment group and control group respectively with the preoperative group in comparison,postoperative 7,14 d within and comparison in preoperative VAS score,WOMAC score and the incidence of aderse eents were difference had statistical significance（P〈0.05）.The treatment group and control group in the 7,14 d line between groups in comparison,VAS score,WOMAC score and the incidence of aderse eents were significantly different.Conclusion：As one of tools of multimodal analgesia,diclofenac sodium＋diclofenac gel is much more safe and effective for treatig eldly patients of knee joint arthritis,comparing with diclofenac sodium group.