全膝关节置换术后膝周持续冰袋加压冷敷的镇痛效果分析

Efficacy of continuous pressure cold therapy for analgesia after total knee arthroplasty

目的：研究人工全膝关节置换术（ TKA）术后膝周持续冰袋加压冷敷的镇痛效果。方法2011年5月至2012年5月，将本组86例欲行单侧TKA的骨关节炎患者随机分成两组：试验组于TKA术后将毛巾包裹的10％盐水冰袋置于膝前、内、外侧冷敷，持续24 h；对照组给予同等规格的常温软包装盐水袋置于膝前、内、外侧外敷，持续48 h；两组均于术后第2天拔除引流管。术后24 h内两组患者均经静脉镇痛泵滴注吗啡行自控镇痛（PCA），疼痛难以忍受时予以肌注吗啡5～10 mg。通过比较两组患者术后膝关节静息和活动痛视觉模拟（ VAS）评分、隐性失血量、吗啡使用情况、主动直腿抬高时间、屈膝90°时间、膝关节活动度（ ROM）以及并发症来分析膝周持续冰袋冷敷的镇痛效果。结果 TKA术后膝周持续冰袋冷敷的患者，其术后36 h内各时间段以及总的吗啡消耗量明显减少（P＜0.01），第一次肌注吗啡的时间亦明显推迟。术后第6、12、24、36 h，试验组静息痛VAS评分显著小于对照组（ P＜0.01），术后24、36 h活动痛VAS评分亦显著小于对照组（ P＜0.01）。术后24 h引流量间接显示，试验组隐性失血量较对照组少（P＜0.01），患者主动直腿抬高时间、屈膝90°时间以及术后两周膝关节活动度比较，试验组均优于对照组（ P＜0.01）。两组在术后伤口愈合、感染发生率、血压、心率、皮疹、呼吸抑制和尿潴留的监测等方面进行比较，差异均无统计学意义，但试验组恶心呕吐发生率小于对照组。结论人工全膝关节置换术后膝周持续10％盐水冰袋冷敷，有助于减少术后麻醉镇痛剂消耗量，减轻术后早期疼痛，且可以有效减少隐性出血量，可促进膝关节功能恢复，且没有明显的不良反应。

Objective To investigate the efficacy of the continuous pressure cold therapy for analgesia after total knee arthroplasty （ TKA） .Methods 86 patients who received unilateral TKA in our hospital from May 2011 to May 2012 were randomly divided into two groups： the knee surgical site was treated with 10%saline ice pack in the trial group , while it was treated with room temperature 10%saline pack in the control group .The drainage tube were removed on the second day .All the patients received the patient-controlled analgesia （ PCA ） for 48 h post operatively .All the data were assessed and compared between the two groups , including the visual analog scale （ VAS） for pain during activity and at rest , the hidden blood loss , the morphine consumption , the time of ability to perform an active straight leg raising , the time of ability to reach 90 degrees knee flexion , the range of motion and complications .Results The continuous pressure cold therapy after TKA significantly reduced the morphine consumption during the 0-36 h postoperative period and the total narcotic consumption , and it also delayed the initial use of the narcotic.The VAS scores at rest of the trial group at postoperative 6, 10, 24 and 36 h were significantly lower than that of the control group , and the VAS scores during activity of the trial group at postoperative 24, 36 h were significantly lower than that of the control group .The drainage volume of the trial group was significantly lower than that of the control group .The time of ability to perform an active straight leg raising and to actively reach 90 degrees knee flexion , as well as the ROM of the knee at the 15th postoperative day, were better in the trial group than those in the control group .There were no significant differences in the incidence of postoperative wound healing , infection, blood pressure, heart rate, rash, respiratory depression, and urine retention between the two groups .The incidence of nausea and vomiting of the trial group was lower than that of the control group .Conclusion The continuous pressure cold therapy can reduce the narcotic consumption and the hidden blood loss .It offers a better pain control method without apparent risks following TKA .