中药联合多模式镇痛对膝关节置换疼痛的疗效观察

Effect of Traditional Chinese Medicine Combined with Multimodal Analgesia on Total Knee Arthroplasty Pain

目的探讨中药联合多模式镇痛对人工全膝关节置换术(total knee arthroplasty,TKA)围手术期的镇痛效果。方法纳入严重膝关节炎首次行膝关节置换患者90例,随机分为A、B、C组,每组30例,A组行术中局部浸润注射+术后静滴帕瑞昔布钠、冰敷;B组行术前口服塞来昔布+术中局部浸润注射+术后静滴帕瑞昔布钠、口服塞来昔布、冰敷;C组行术前中药内服+术中局部浸润注射+术后静滴帕瑞昔布钠、中药内服、冰敷。分析各组术后不同时间活动、静息状态下疼痛视觉模拟评分(VAS),不良反应及膝关节KSS评分。结果 3组术后24 h、48 h、72 h,B、C两组患者静息状态下VAS评分均低于A组,差异均有统计学意义(P<0.05);3组术后48 h、72 h,B、C两组患者活动状态下VAS评分均低于A组,差异均有统计学意义(P<0.05);膝关节KSS评分结果 :B、C两组KSS评分均高于A组,而C组KSS评分高于B组,差异均有统计学意义(P<0.05);3组中术后2周内出现的恶心、呕吐例数差异无统计学意义(P>0.05),均未出现双下肢深静脉血栓及皮肤坏死感染情况。结论中药联合多模式镇痛在TKA围手术期的镇痛效果比较理想且未提高不良反应。

Objective To evaluate the effects of traditional Chinese medicine combined with multimodal analgesia on total knee arthroplasty pain. Methods 90 patients with serious osteoarthritis who underwent unilateral knee arthroplasty for the first time were enrolled in the study. The patients were randomly divided into group A, B, C（n=30）. Group A received local infiltration analgesia during operation and received Parecoxib, continuous cryotherapy after replacement. Group B received celecoxib before replacement, local infiltration analgesia during replacement and Parecoxib, celecoxib combined continuous cryotherapy after replacement. Group C received traditional Chinese medicine before replacement,local infiltration analgesia during replacement and Parecoxib,traditional chinese medicine combined continuous cryotherapy after replacement. Analysis under different time activity, resting between groups of postoperative pain visual analogue scale（VAS）, adverse reactions and knee KSS score. Results After 24, 48, 72 h of operation, VAS score of group B and C patients in resting state were lowerthan that in group A（P〈0.05）. After 48, 72 h of operation, VAS score of group B and C patients in active state were less than that in group A（P〈0.05）. KSS score in group B and C was higher than that of group A（P〈0.05）; scores in Group C were higher than that of group B, there was no significant difference（P〈0.05）. There was no significant difference in the number of nausea and vomiting between the three groups after two weeks of operation（P〈0.05）, It did not appear the deep vein thrombosis of lower limbs and skin necrosis infection status. Conclusion The effect of Chinese medicine combined with multi-modality analgesiais during Total Knee Arthroplasty is good, no increasing adverse reactions.