糖尿病对膝关节置换术后急性疼痛的影响:前瞻性队列研究

Acute Pain after Knee Replacement in Diabetic Patients:A Prospective Cohort Study

目的比较有/无糖尿病的膝关节骨关节炎(knee osteoarthritis,KOA)患者关节置换术后急性疼痛的差异。方法前瞻性收集并分析2017年10月至2018年2月在首都医科大学附属北京朝阳医院行单侧全膝关节置换术(total knee arthroplasty,TKA)患者的临床资料。依据是否合并糖尿病,分为糖尿病组和非糖尿病组。两组患者均采用蛛网膜下腔麻醉联合单次股神经阻滞麻醉,术后均采用经静脉患者自控镇痛(patient controlled intravenousanalgesia,PCIA),若静息状态下视觉模拟评分(visual analogue scale,VAS)>4分时,则口服羟考酮5 mg镇痛。比较两组术前及术后4 h、1 d、2 d、3 d、4 d、5 d静息/运动状态VAS评分及术后不同时间点镇痛泵内药物用量、口服羟考酮剂量。记录PCIA使用期间不良反应发生情况。结果共117例符合纳入和排除标准的KOA患者入选本研究,其中糖尿病组49例、非糖尿病组68例。两组患者术前及术后4 h、1 d静息/运动状态VAS评分差异无统计学意义(P均>0.05),糖尿病组术后2、3、4、5 d静息/运动状态VAS评分明显高于非糖尿病组(P均<0.05)。两组患者术后4 h内镇痛泵用药量、术后1 d口服羟考酮剂量差异无统计学意义(P均>0.05),糖尿病组术后2、3、4、5 d口服羟考酮剂量及术后24、48 d内镇痛泵用药量多于非糖尿病组(P均<0.05)。两组PCIA使用期间恶心呕吐、头晕发生率无统计学差异(P均>0.05)。结论糖尿病可加剧KOA患者TKA术后(术后2~5 d)急性疼痛,增加早期阿片类镇痛药物的使用量。

Objective To compare the difference of acute pain after joint replacement in patients with knee osteoarthritis(KOA)with or without diabetes.Methods Clinical data of patients with total knee arthroplasty(TKA)who underwent surgery at Beijing Chaoyang Hospital,Capital Medical University from October 2017 to February 2018 were prospectively collected and analyzed.They were divided into the diabetes group and the non-diabetes group according to whether they had diabetes or not.Patients of the two groups were given subarachnoid anesthesia combined with single femoral nerve block anesthesia.After the operation,patient controlled intravenousanalgesia(PCIA)was applied.If the visual analogue scale(VAS)score exceeded 4 in the resting state,the patients would take 5 mg of Oxycodone analgesia orally.VAS scores of resting pain/exercise pain,drug dosage in postoperative analgesia pump,and oral oxycodone dose were compared between the two groups before,4 h,1 d,2 d,3 d,4 d and 5 d after the operation.The occurrence of adverse reactionsduring the use of narcotic drugs was recorded.Results A total of 117 KOA patients meeting the inclusion and exclusion criteria were included in this study,including 49 in the diabetic group and 68 in the non-diabetic group.VAS scores of rest pain/exercise pain were not significantly different between the two groups before,4 h,and 1 d after the operation(all P>0.05).VAS scores of rest pain/exercise pain were significantly higher in the diabetic group than in the non-diabetic group 2 d,3 d,4 d,and 5 d after the operation(all P<0.05).There was no statistically significant difference between the two groups in term of the dosage of analgesia pump 4 h after the operation and the dosage of oral oxycodone 1 d after the operation(all P>0.05).The dosage of oral oxycodone 2 d,3 d,4 d and 5 d after the operation and the dosage of oral oxycodone 24 h and 48 h after the operation of the diabetes group were higher than that of the non-diabetes group(all P<0.05).There was no statistical difference in the incidence of nausea,vomiting,and dizziness during applying PCIA between the two groups(all P>0.05).Conclusion Diabetes can aggravate acute pain in KOA patients after TKA(2-5 d after TKA)and increase the use of opioid analgesics in the early stage.