镇痛药物在膝关节置换术后的应用效果与经济学评价

Application Effect and Economic Evaluation of Analgesia Drug After Knee Arthroplasty

目的探讨膝关节置换术后镇痛的药物疗效与经济学评价。方法选取2021年1月至2022年12月于新乡市中心医院接受膝关节置换术治疗患者180例作为研究对象,按照随机数字表法分为A组(术后接受氟比洛芬酯镇痛)、B组(术后接受帕瑞昔布镇痛)及C组(术后接受酮咯酸氨丁三醇镇痛),各60例。对比镇痛效果、视觉模拟疼痛评分(VAS)、术后首次下床时间、48 h内PCIA按压次数、膝关节活动度及不良反应发生率。结果重复测量方差分析显示,3组静息、咳嗽状态下VAS评分、膝关节活动度时间、组间及交互效应有统计学意义(P<0.05);C组T_(1)、T_(2)、T_(3)、T_(4)时点的静息、咳嗽状态下VAS评分分别低于A组和B组,而T_(0)、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时点的膝关节活动度均高于A组和B组(P<0.05)。C组镇痛总满意度高于A组和B组(P<0.05)。C组的术后首次下床时间、48 h内PCIA按压次数均低于A组和B组(P<0.05)。C组的住院时间均短于A组和B组(P<0.05);B组和C组的住院费用、镇痛医疗成本均低于A组(P<0.05);B组的住院费用、镇痛医疗成本与C组差异无统计学意义(P>0.05)。3组不良反应总发生率差异无统计学意义(P>0.05)。结论酮咯酸氨丁三醇镇痛用于膝关节置换术后有利于减轻患者疼痛和缩短首次下床时间。

Objective To investigate the drug efficacy and economic evaluation of analgesia after knee replacement.Methods A total of 180 patients who underwent knee arthroplasty in our hospital from January 2021 to December 2022 were selected as the study subjects,and were divided into group A(postoperative analgesia with flurbiproxen),group B(postoperative analgesia with parexib)and group C(postoperative analgesia with ketorolac tromethamine)according to random number table method,with 60 cases each.The analgesic effect,visual analogue pain scale(VAS),first time to get out of bed after surgery,PCIA compression times within 48 hours,knee motion and incidence of adverse reactions were compared.Results Repeated measurement analysis of variance showed that there were statistically significant differences between group,time and interaction effects in VAS score at rest and cough,the existence time of knee motion in the three groups(P<0.05).The resting VAS scores and coughing VAS scores at T_(1),T_(2),T_(3) and T_(4) in group C were lower than those in group A and group B,respectively,while the knee joint motion at T_(0),T_(1),T_(2),T_(3),T_(4) and T_(5) were higher than those in groups A and B(P<0.05).The total satisfaction of analgesia in group C was higher than that in groups A and B(P<0.05).The first time of getting out of bed and the number of PCIA compressions within 48 hours in group C were lower than those in group A and group B(P<0.05).The length of hospital stay in group C was shorter than that in groups A and B(P<0.05).The hospitalization cost and analgesic medical cost in groups B and C were lower than those in group A(P<0.05).There was no significant difference in hospitalization cost and analgesic medical cost between group B and group C(P>0.05).There was no significant difference in the total incidence of adverse reactions among the three groups(P>0.05).Conclusion Ketorolac tropanol analgesia after knee joint replacement is beneficial to reduce pain and shorten the first time of getting out of bed.