全膝关节置换围术期减少止痛药使用方法的研究

Study of the methods of reducing the use of pain-relieving drugs during perioperative period of total knee arthroplasty

目的探讨全膝关节置换术围术期非药物方法对术后疼痛的干预,明确围术期非药物方法是否可以缓解术后患者的疼痛及减少塞来昔布的应用。方法选择2016年1月~2017年9月西安交通大学医学院附属红会医院关节外科行单侧全膝关节置换术的203例患者作为研究对象,按术后口服塞来昔布剂量是否≥800 mg分为A组(塞来昔布剂量<800 mg,105例)和B组(塞来昔布剂量≥800 mg,98例)。应用单因素分析及多因素Logistic回归分析探讨患者增加塞来昔布使用的危险因素。结果 A组使用全麻+股神经阻滞麻醉方式,"鸡尾酒"关节腔注射以及术后给予心理安慰、电疗、冷冻疗法例数多于B组,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现:全麻+股神经阻滞,"鸡尾酒"关节腔灌注及术后给予心理安慰、电疗是增加塞来昔布使用的独立危险因素(P<0.05)。结论给予全麻+股神经阻滞麻醉方式、"鸡尾酒"关节腔注射及术后给予心理安慰和电疗可以缓解行全膝关节置换术患者术后疼痛及减少止痛药物的使用。

Objective To investigate the intervention of non-drug method for postoperative pain in total knee arthroplasty, in order to clarify whether perioperative non-drug therapy can relieve pain in postoperative patients and reduce the use of Celecoxib. Methods 203 patients underwent unilateral total knee arthroplasty in Department of Joint Surgery, Honghui Hospital Affiliated to Xi′an Jiaotong University Medical College from January 2016 to September 2017 were selected, then they were divided into group A （Celecoxib ＜ 800 mg, 105 cases） and group B （Celecoxib ≥ 800 mg, 98 cases）, according to whether the dosage of oral Celecoxib was ≥ 800 mg. The risk factors of increase the use of Celecoxib were investigated by single-factor analysis and multifactor Logistic regression analysis. Results The cases of general anesthesia ＋ femoral nerve block anesthesia, ＂cocktail＂ intra-articular injection and postoperative psychological comfort, electrotherapy, cryotherapy in the group A were more than those in the group B, with statistically significant difference （P 〈 0.05）. Multifactor Logistic regression analysis showed： general anesthesia ＋ femoral nerve block, ＂cocktail＂ intra-articular injection and postoperative psychological comfort, electrotherapy were independent risk factors of increase the use of Celecoxib （P 〈 0.05）. Conclusion The application of general anesthesia ＋ femoral nerve block anesthesia, ＂cocktail＂ joint cavity injection and postoperative psychological comfort, electrotherapy can alleviate postoperative pain and reduce the use of analgesic drugs after total knee arthroplasty.