2种多模式镇痛方案在膝关节周围骨折术后早期镇痛的效果

The Effects of two Kinds of Multimodal Analgesia Treatment on the Early Postoperative Pain of the Fracture Around Knee Joint

目的:比较2种多模式镇痛方案对膝关节周围骨折镇痛效果。方法:选择我院2014年1月-2016年3月112例膝关节周围骨折的病例,随机分成观察组和对照组2组,观察组术前及术后采用丁丙诺啡透皮贴剂外用、西乐葆及乐瑞卡口服,对照组采用曲马多肌注、氟比洛芬酯静滴或者帕瑞昔布静注,记录术后6、24、48小时静息痛的疼痛评分(VAS评分)以及术后24、48小时行膝关节功能锻炼后的VAS评分,行术后24、48小时C-反应蛋白(CRP)及白介素-6(IL-6)检查,随访评价膝关节功能及骨折愈合情况。结果:观察组、对照组2组患者夜间睡眠良好,术后6、24、48小时静息痛的疼痛评分(VAS评分)以及术后24、48小时行膝关节功能锻炼后的VAS评分,无统计学差异;术后C-反应蛋白(CRP)及白介素-6(IL-6),观察组均值>对照组均值,但无统计学差异,术后2组患者均无局部皮肤坏死及皮疹,伤口愈合顺利拆线,术后骨折愈合时间(P>0.05)。结论:2种多模式镇痛方案对膝关节周围骨折具有效果,外敷及口服镇痛方案具有使用更方便,更经济实惠。

Objective:To compare the ffctiveness of two types of multimodal analgesia treatment of the fractures around knee joint.Method:112 patients who had fractures around knee joints and were treated in qingyuan peoples hospital betwee January 2014 and march 2016,were enrolled and randomized to group A and group B.The group A received Celebrex,Transermal buprenorphine,Pregabalin cap-sules.The group B received Tramadol and anyone of Flurbiprofen Axetil and Parecoxib Sodium.VAS scores were recorded at6 h,24h,48h at rest and at 24h,48h during CPM postoperatively.The values of CRP and IL-6 were tested at 24h,48h postoperatively.The knee function and fracture healing time were fllowed up.Result:All patients slept well at night postoperatively.VAS scores at 6 h,24h,48h at rest and at 24h,48h during CPM after operation were not statistically significant(p>0.05)between two groups.The average values of the CRP were higher than the IL-6,but there was not statistically sigificant(p>0.05).There was no localization skin necrosis or skin rash in the two groups.All Incision healed well.Fracture healing times between two groups were not stisticlly significant differentiated(p>0.05).Conclusion:The two kinds of multimodal analgesia have good effects on fracture around the knee joint.Analgesis by way of skin and oral are more convenient and economical.