对乙酰氨基酚不同给药途径下双侧全膝关节置换术后镇痛效果的临床观察

Clinical observation of analgesic effect of different administration routes of acetaminophen after bilateral total knee arthroplasty

目的探讨口服与静脉注射给药方式对双侧全膝关节置换术术后镇痛效果的差异。方法将选择入院行双侧全膝关节置换手术的患者80例,随机分为静脉注射组(A组)与口服组(B组),各40例。A组接受静脉注射对乙酰氨基酚1 g和口服安慰剂;B组接受对乙酰氨基酚片1 g和静脉注射相同容量的生理盐水。手术结束后进入PACU时随机以2种不同方式给予对乙酰氨基酚,记录转入PACU时(T0)、用药后30 min(T1)、回病房后1 h(T2)、2 h(T3)、3 h(T4)的VAS评分及平均动脉压(MAP)的变化;当患者疼痛评分>4分时给予静脉镇痛泵进行术后辅助镇痛,记录2组使用术后镇痛泵距离进入PACU的时间;观察术后恶心、呕吐,过敏性皮炎发生率。结果2组在T1~T4时间节点组间VAS评分,术后开始使用镇痛泵的时间以及术后不良反应发生率比较,差异均无统计学意义(P>0.05);A组血压在T1、T2降低且与T0相比差异有统计学意义(P<0.05);2组间比较,T1时间点平均动脉压(MAP)差异显著(P<0.01)。结论在椎管内麻醉下接受双侧全膝关节置换术的患者中,静脉注射或口服对乙酰氨基酚在术后镇痛效果上没有明显差异,静脉用药短期内对平均动脉压影响更显著。

Objective To investigate the difference in analgesic effect between oral and intravenous acetaminophen after bilateral total knee arthroplasty.Methods A total of 80 patients who underwent bilateral total knee arthroplasty were selected and randomly divided into an intravenous injection group(Group A)and an oral administration group(Group B),with 40 cases in each group.Group A received intravenous acetaminophen(1 g)and oral placebo,while Group B received acetaminophen tablets(1 g)and the same volume of normal saline intravenously.After operation,acetaminophen was given randomly in two different ways when they were transferred to PACU.The VAS scores and the changes of mean arterial pressure(MAP)were recorded at the time of entering PACU(T0),30 min(T1)after administration,1 h(T2),2 h(T3),3 h(T4)after returning to the ward.When the patient’s pain score was more than 4 points,an intravenous analgesia pump was given for postoperative auxiliary analgesia.The time from the beginning to use the postoperative analgesia pump to entering PACU was recorded in the two groups.Moreover,the incidence of postoperative nausea,vomiting and allergic dermatitis were observed.Results There was no signi?cant di?erence between the two groups in the VAS score at T1-T4,the time from the beginning to use a postoperative analgesia pump to entering PACU and the incidence of postoperative adverse reactions(P>0.05).The MAP in Group A significantly decreased at T1 and T2 compared with that at T0(P<0.05).The MAP at T1 in Group A was signicantly lower than that in Group B(P<0.01).Conclusion In the patients who underwent bilateral total knee arthroplasty under spinal anesthesia,there was no signicant difference in postoperative analgesic effect between the administration of intravenous or oral acetaminophen,yet the intravenous administration has a more significant effect on MAP in a short period of time.