多模式镇痛对髌骨骨折患者术后膝关节功能及疼痛程度的影响

Effect of Multimodal Analgesia on Knee Joint Function and Pain Degree in Patients with Patella Fractures

目的:探究多模式镇痛(MMA)对髌骨骨折患者术后膝关节功能及疼痛程度的影响。方法:选取2018年1月—2020年6月商丘市第一人民医院126例接受髌骨骨折手术治疗的患者,按随机数表法分为对照组和观察组,每组各63例。对照组予以常规镇痛,即术中予以股神经阻滞(FNB)+坐骨神经阻滞(SNB);观察组予以MMA,即术前予以塞来昔布口服预防性镇痛,术中予以FNB+SNB,术后予以帕瑞昔布钠静滴。对比两组患者入院时及术后6 h、12 h、24 h、48 h膝关节在静息与运动状态下的疼痛视觉模拟(VAS)评分,对比两组患者入院时及术后1月的膝关节活动度(ROM)与Lysholm评分,对比两组患者入院时及术后24 h、48 h的简易智力状态量表(MMSE)评分,记录两组患者术后的镇痛补救及不良反应情况。结果:术后不同时间点,两组在静息与运动状态下的VAS评分均低于入院时,且观察组均低于对照组,差异有统计学意义(P<0.05)。术后两组患者膝关节ROM及Lysholm评分均高于入院时,且观察组均高于对照组,差异有统计学意义(t=2.560、3.511,P<0.05)。两组患者不同时间点的MMSE评分比较,差异无统计学意义(P>0.05),两组患者组间比较,差异无统计学意义(t=0.170、0.083、0.329,P>0.05)。观察组术后的镇痛补救率为20.63%,低于对照组的39.68%,差异有统计学意义(χ^(2)=0.020,P<0.05)。两组患者术后不良反应发生率比较,差异无统计学意义(χ^(2)=1.000、0.403、0.434、0.403、0.559,P>0.05)。结论:MMA方案可有效缓解髌骨骨折患者的术后疼痛,促进膝关节功能恢复,值得临床推广应用。

Objective: To explore the effect of multimodal analgesia(MMA) on knee joint function and pain degree in patients with patella fractures. Methods: A total of 126 patients who received surgical treatment of patella fractures in the hospital from January 2018 to June 2020 were selected and divided into the control group and the observation group according to the random number table method, with 63 cases in each group. The control group was given routine analgesia, namely, intraoperative femoral nerve block(FNB) + sciatic nerve block(SNB), and the observation group was given MMA, namely, oral prophylactic analgesia with celecoxib before operation, and FNB + intraoperative SNB, intravenous infusion of parecoxib sodium was given after surgery.The visual analog(VAS) scores of knee joint pain at rest and in motion state were compared between the two groups at admission and at 6 h, 12 h, 24 h, and 48 h after operation. The knee range of motion(ROM) and Lysholm score were compared between the two groups at admission and 1 month after operation. The scores of the Mini-Mental State Scale(MMSE) were compared between the two groups at admission and at 24 h and 48 h after operation. The postoperative analgesic rescue and adverse reactions of the two groups of patients were recorded. Results: At different time points after the operation, the VAS scores of the two groups in resting and exercise states were lower than those at admission, and the observation group was lower than the control group, and the difference was statistically significant(P<0.05). The knee ROM and Lysholm scores of the two groups after operation were higher than those at admission, and the observation group was higher than the control group, the difference was statistically significant(t=2.560, 3.511, P<0.05). There was no statistically significant difference in MMSE scores between the two groups at different time points(t=0.170, 0.083, 0.329, P>0.05). The postoperative analgesic recovery rate of the observation group was 20.63%, which was lower than 39.68% of the control group, and the difference was statistically significant(χ^(2)=0.020, P<0.05). There was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups(χ^(2)=1.000, 0.403, 0.434, 0.403,0.559, P>0.05). Conclusion: The MMA program can effectively relieve postoperative pain in patients with patellar fractures and promote the recovery of knee joint function, which is worthy of clinical application.