多模式镇痛对全膝关节置换术患者术后镇痛效果、血流动力学和炎性反应的影响

Effects of Multimodal Analgesia on Postoperative Analgesia,Hemodynamics and Inflammatory Response in Patients Undergoing Total Knee Arthroplasty

目的探究多模式镇痛对全膝关节置换术患者术后镇痛效果、血流动力学和炎性反应的影响。方法选取2018年1月—2019年4月行人工全膝关节置换术的150例患者,根据镇痛方法的不同将患者分为观察组和对照组,每组75例。观察组采用多模式镇痛,对照组采用静脉自控镇痛。比较2组术后不同时间的视觉模拟量表(VAS)评分和平均动脉压(MAP),观察术后下地时间、行走距离、住院时间以及术后1 d的血清C反应蛋白(CRP)和白介素-6(IL-6)水平。结果观察组术后12、24和48 h的VAS评分均明显低于对照组(P<0.01)。观察组术后下地时间以及住院时间均较对照组短,行走距离较对照组远(P<0.01)。观察组术后6、12、24、48和72 h的MAP均明显低于对照组(P<0.01)。观察组术后血清CRP和IL-6水平均明显低于对照组(P<0.01)。结论多模式镇痛可有效降低人工全膝关节置换术后的疼痛程度,对血流动力学影响较小且可降低机体炎性反应水平,临床可视情况应用多模式镇痛,提升患者生活质量。

Objective To investigate the effects of multimodal analgesia on postoperative analgesia,hemodynamics and inflammatory response in patients undergoing total knee arthroplasty(TKA).Methods A total of 150 patients who underwent TKA from January 2018 to April 2019 were selected.The patients were divided into observation group(n=75)and control group(n=75)according to different analgesic methods.The observation group received multimodal analgesia,and the control group received intravenous self-controlled analgesia.The visual analogue scale(VAS)score and mean arterial pressure(MAP)were compared between the two groups at different time points after operation.Time of leaving bed,walking distance,length of hospital stay,and serum C-reactive protein(CRP)and interleukin-6(IL-6)levels at 1 d after operation were observed.Results VAS scores in the observation group at 12,24 and 48 h after operation were significantly lower than those in the control group(P<0.01).The time of leaving bed and length of hospital stay were shorter in the observation group than in the control group,while the walking distance was longer in the observation group than in the control group(P<0.01).The MAP of the observation group at 6,12,24,48 and 72 h after operation was significantly lower than that of the control group(P<0.01).Postoperative serum CRP and IL-6 levels in the observation group were significantly lower than those in the control group(P<0.01).Conclusion Multimodal analgesia can effectively reduce the pain after TKA,has fewer effects on hemodynamics,and reduce the body's inflammatory response.In clinical practice,multimodal analgesia can be applied,if necessary,to improve the quality of life of patients.