中西医协同镇痛方案在人工膝关节置换围手术期的临床疗效观察

Clinical observation of traditional Chinese and western medicine synergistic analgesic program in perioperative knee arthroplasty

[目的]观察中西医协同镇痛方案在人工膝关节置换围手术期的临床疗效。[方法]2011年8月～2012年2月收治行单侧膝关节置换术患者72例。随机分为实验组(H组)和对照组(C组),每组各36例。分别应用河南省中医院关节外科镇痛方案和长征医院关节外科镇痛方案,对术前、术后静息痛和运动痛、关节活动度及肿胀进行比较。[结果]术前二组患者静息痛VAS评分比较无显著性差异,术后6、12、24、48、72 h静息痛VAS评分H组小于C组,术后72 h H组、C组两组间评分无显著性差异(P>0.05)。术前二组患者运动痛比较无显著差异,术后6、12、24、48、72 h运动痛VAS评分比较H组小于C组,但组间比较在统计学意义上无显著性差异(P>0.05)。术后1、3 d,1、2周膝关节活动度数据H组大于C组,比较差异有统计学意义(P<0.05),术后4周随访二组活动度比较无显著性差异(P>0.05)。H组和C组术肢肿胀程度及例数在术后3 d二者相近,随术后时间延长,存在明显差异(P<0.05)。[结论]中西医协同镇痛方案在全膝关节置换术围手术期多模式疼痛管理中有助于减轻患者的术后疼痛和肿胀,并减少术后总的麻醉剂使用量。

[ Objective ] To evaluate the clinical effects of traditional Chinese and western meidicne synergistic analgesic program in perioperative knee arthroplasty. [ Methods ] Seventy- two patients underwent unilateral knee arthroplasty from Au gust 2011 to February 2012, and were randomly divided into the experiment （group H, 36 cases） and the control group （group C, 36 cases） . The analgesic programs of joint surgery of Henan province hospital of TCM and joint surgery of Changzheng hos pital were respectively used to compare the preoperative and postoperative pain at rest, pain on motion, joint range of motion and swelling. [ Results ] There was no significant difference on pain at rest VAS scores between the two groups of patients preopera- tively, while after the operation, the evaluation of pain at rest VAS scores of group H was smaller than the one of group C in 6, 12, 24, 48, 72 h respectively, and the difference disappeared after 72 h. In terms of pain on motion, the above two groups were the same as that of pain at rest, but the comparison between groups did not have significant differences on statistics （ P 〉 O. 05 ） . Tile statistics of the group H was larger than that of the group C in 1, 3 d, 1, 2 w after the operation, which had much significance in comparative differences （ P 〈 0.05 ） , while after 4 w the difference disappeared （ P 〉 0.05 ） . The degree of swelling between the above two groups were almost the same in 3 days postoperatively, and the difference became apparent （ P 〈 0. 05 ） with the extension of the time postoperatively. [ Conclusion ] The multi - mode pain managements of traditional Chinese and western medicine synergistic analgesic program in knee perioperative arthroplasty contribute to alleviate postoperative pain and swelling, and reduce the total amount of postoperative anesthetic.