氨酚曲马多在人工全膝关节围置换期镇痛中的作用及安全性

Analgesic effect and security of tramadol/acetaminophen during perioperative total knee arthroplasty

背景:镇痛治疗在人工全膝关节置换的恢复过程中发挥着重要作用,是进行有效功能锻炼、提高围术期生活质量的保证。目的:评价人工全膝关节置换围术期联合应用氨酚曲马多和静脉自控镇痛的有效性和安全性。方法:选取2010-09/2011-09在山东大学附属省立医院行单侧人工全膝关节置换的患者70例,多模式镇痛组使用静脉自控镇痛的同时口服氨酚曲马多至置换后第7天;对照组仅使用静脉自控镇痛。结果与结论:多模式镇痛组置换后的前3d目测类比评分均低于对照组(P<0.05),功能锻炼开始后两组评分差异无显著性意义,多模式镇痛组置换后第7天膝关节活动度和治疗总体满意度高于对照组(P<0.05),不良反应的发生率和严重程度方面两组之间差异无显著性意义。结果可见人工全膝关节置换围术期应用氨酚曲马多结合静脉自控镇痛能提高功能锻炼的质量和治疗满意度,且未增加药物不良反应的风险。

BACKGROUND： Analgesia plays an important role in the rehabilitation of total knee arthroplasty （THA）, which ensures effective function exercise and improves perioperative life quality. OBJECTIVE： To evaluate the analgesic effect and security of tramadol/acetaminophen combined with patient-controlled intravenous analgesia during perioperative THA. METHODS： Totally 70 patients who received unilateral THA from Affiliated Provincial Hospital of Shandong University from September 2010 to September 2011 were divided into two groups. Patient in group A （multi-model analgesia group） were treated with patient-controlled intravenous analgesia and oral tramadol/acetaminophen for 7 days after operation. Patients in group B （control group） were only treated with patient-controlled intravenous analgesia. RESULTS AND CONCLUSION： Visual analogue scale of the group A was lower than that of the group B at the first three days after operation （P 〈 0.05）, but during the period of exercise, there was no statistical difference between the two groups. The range of motion and overall satisfaction with the treatment in the group A were significantly higher than those in the group B at postoperative 7 days （P 〈 0.05）, and there was no statistical difference in the incidence of adverse reactions and severity between the two groups. The results showed that application of tramadol/acetaminophen combined with patient-controlled intravenous analgesia during perioperative THA can improve the efficiency of function exercise and satisfaction with the treatment, and without increasing the risk of adverse drug reactions.