全膝关节置换术198例患者镇痛方案分析

Analgesic regimen analysis of 198 patients undergoing total knee arthroplasty

目的对医院接受人工全膝关节置换患者术后镇痛方案进行评价。方法选取行人工全膝关节置换患者203例作为研究对象,采用回顾分析法对患者术后镇痛方案进行分析,评估人工全膝关节置换镇痛方案。结果 203例患者采用多模式镇痛方案的患者占80%,主要是单纯患者自控镇痛(PCA,19.7%)、PCA-浸润麻醉两模式(49.75%)和PCA-浸润麻醉-神经阻滞三模式(28.08%)。与PCA单模式镇痛相比,PCA-神经阻滞两模式、PCA-神经阻滞-浸润麻醉三模式镇痛时的人均等效吗啡需求量显著少于PCA单模式镇痛(P<0.01)。联合镇痛组术后下床活动时间早于单纯PCA组:单纯PCA组人均为5±1.19 d,PCA-神经阻滞两模式组为3.98±1.04 d,PCA-神经阻滞-浸润麻醉三模式组为3.82±1.29 d(P<0.01);不同镇痛方案在开始康复训练时间方面未表现出明显差异。不同镇痛方案术后疼痛的主诉、住院时间和安全性事件的发生率无明显差异。结论多模式镇痛方案较单纯PCA可明显节省阿片类药物用量,患者下床活动时间更早,在疼痛主诉及安全性方面无明显差异。

Objective To evaluate the analgesic regimen for patients after total knee arthroplasty in hospital.Methods 203 patients who underwent total knee arthroplasty were selected.The analgesic schemes of total knee arthroplasty were evaluated by retrospective analysis.Results Multimodal analgesia was used in 80%of the 203 patients,mainly single-mode of PCA(19.7%),two modes of PCA-infiltration anesthesia(49.75%)and three modes of PCA-infiltration anesthesia-nerve block(28.08%).The per capita equivalent morphine requirement of PCA-nerve block and PCA-nerve block-infiltration anesthesia three-mode analgesia was significantly less than that of PCA single-mode analgesia(P<0.01).The time of beginning to get out of bed after different analgesia schemes showed significant differences.In combined analgesia group it was earlier than that of PCA group:5±1.19 d in the PCA single-mode analgesia,3.98±1.04 d in the PCA-nerve block 2 mode group,and 3.82±1.29 d in the PCA-nerve block-infiltration anesthesia three-mode analgesia(P<0.01).No difference was observed in the time of starting rehabilitation training among different groups.There were no significant difference in complaints of pain and length of hospital stay among different analgesic schemes.The incidence of adverse drug events showed no difference.Conclusion In this study,the multi-modal analgesic scheme significantly reduced opioids dose and showed earlier beginning to get out of bed than single-mode of PCA.There is no significant difference in pain complaints and safety.