冷疗、耳穴联合多模式镇痛对全膝关节置换术后康复效果的临床研究

Effect of Cold Therapy and Auricular Acupoints Combined with Multimodal Analgesia on Rehabilitation after Total Knee Arthroplasty

目的:比较结合冷疗和耳穴的多模式镇痛对全膝关节置换术(TKA)后康复的疗效。方法:经伦理委员会批准,样本量估算,以笔者所在医院收治的20例膝骨关节炎患者作为研究对象,将其随机分为试验组和对照组各10例,比较术后6 h、24 h、48 h、7 d、14 d疼痛程度(VAS评分)和关节活动度,以及隐性失血量。结果:两组术后6、24 h的VAS评分比较差异无统计学意义(P>0.05);试验组术后48 h、7 d、14 d的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组术后6、24、48 h关节活动度比较差异无统计学意义(P>0.05);试验组在术后7、14 d关节活动度均高于对照组,差异均有统计学意义(P<0.05)。试验组患者隐性失血量低于对照组,差异均有统计学意义(P<0.05)。结论:结合冷疗、耳穴的多模式镇痛,能显著减少术后隐性失血量,减少术后关节肿胀、疼痛,改善术后ROM,操作简易,具有很高的临床应用价值。

Objective:To compare the effects of multimodal analgesia combined with cold therapy and auricular acupoints on rehabilitation after total knee arthroplasty.Method:According to the ethics committee approval and sample size estimation,20 patients with knee osteoarthritis admitted to our hospital were randomly divided into the experimental group and the control group,10 cases in each group.The pain level(VAS score),joint mobility,the hidden blood loss were compared at 6 h,24 h,48 h,7 d,14 d after surgery were compared.Result:There were no significant differences in VAS score between the two groups at 6 h,24 h after operation(P>0.05),but the VAS score at 48 h,7 d and 14 d after operation in the experimental group were significantly lower than those in the control group(P<0.05).There were no significant differences in joint motion between the two groups at 6 h,24 h and 48 h after operation(P>0.05).The range of motion of the experimental group higher than those of the control group at 7 d and 14 d after operation,and the differences were statistically significant(P<0.05).The hidden blood loss in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Multimodal analgesia combined with cold therapy and auricular acupoints,can significantly reduce the hidden blood loss,joint swelling and pain,improve ROM.It is easy to operate and has high clinical value.