文章摘要
张坤,彭永刚,姜任东,苗润青,任姜栋,张晓岗.鸡尾酒疗法联合硬膜外单次小剂量吗啡对全膝关节置换术后疼痛控制的研究.骨科,2019,10(1):14-18
鸡尾酒疗法联合硬膜外单次小剂量吗啡对全膝关节置换术后疼痛控制的研究
Control of pain after total knee arthroplasty by cocktail therapy combined with epidural single dose of morphine
投稿时间:2018-10-04  
DOI:10.3969/j.issn.1674-8573.2019.01.003
中文关键词: 膝关节置换  鸡尾酒疗法  硬膜外镇痛  糖皮质激素  吗啡
英文关键词: Knee replacement  Cocktail therapy  Epidural analgesia  Glucocorticoid  Morphine
基金项目:新疆维吾尔自治区自然科学基金(2016D01C291)
作者单位E-mail
张坤 新疆医科大学第一附属医院关节外科乌鲁木齐 830054  
彭永刚 新疆医科大学第一附属医院关节外科乌鲁木齐 830054  
姜任东 新疆医科大学第一附属医院关节外科乌鲁木齐 830054  
苗润青 新疆医科大学第一附属医院关节外科乌鲁木齐 830054  
任姜栋 新疆医科大学第一附属医院关节外科乌鲁木齐 830054  
张晓岗 新疆医科大学第一附属医院关节外科乌鲁木齐 830054 zxgjohn1972@sina.com 
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中文摘要:
      目的 研究鸡尾酒疗法联合硬膜外单次小剂量吗啡对全膝关节置换术(total knee arthroplasty, TKA)后疼痛的控制作用。方法 采用随机双盲对照研究,选取2018年2月至2018年9月我院收治的拟行初次单侧TKA的膝骨关节炎病人160例,随机分为4组,每组40例,麻醉方式均采用硬膜外麻醉。A组病人给予鸡尾酒疗法(含激素)联合硬膜外单次小剂量吗啡;B组病人给予鸡尾酒疗法(不含激素)联合硬膜外单次小剂量吗啡;C组病人给予单纯鸡尾酒疗法(含激素);D组为对照组,给予单纯鸡尾酒疗法(不含激素)。记录4组病人术后2、6、12、24、48、72 h静息状态下及术后24、48、72 h活动状态下的疼痛视觉模拟量表(visual analogue score, VAS)评分,术后48 h、72 h、4 d、5 d的膝关节最大屈曲活动度以及术后不良反应。结果 4组病人术后静息状态下、活动状态下的VAS评分及膝关节活动度总体比较,差异均有统计学意义(F=10.798,P<0.001;F=6.220,P=0.001;F=6.075,P=0.001)。A、B、C组术后静息状态、运动状态下的VAS评分均显著低于D组,且其膝关节活动度均显著大于D组,差异均有统计学意义(P均<0.05)。C组病人静息状态下VAS评分的总体均数高于A组,差值为0.52,差异有统计学意义(P=0.005)。结论 鸡尾酒疗法联合硬膜外单次小剂量吗啡在TKA术后显示出更强且更协同的镇痛效果,可更好地改善术后膝关节活动度;在无激素禁忌及不良反应的条件下,建议“鸡尾酒”混合镇痛药中添加糖皮质激素。
英文摘要:
      Objective To study the effect of cocktail therapy combined with epidural single low dose morphine on pain control after total knee arthroplasty (TKA). Methods A randomized, double-blind, controlled study was conducted on 160 patients with knee osteoarthritis who were treated with unilateral TKA in our hospital from February 2018 to September 2018 for the first time. Epidural anesthesia was used in all cases. They were randomly divided into four groups, 40 patients in each group: group A was given cocktail therapy (hormone-containing) combined with epidural single low dose morphine; group B was given cocktail therapy (hormone-free) combined with epidural single low dose morphine; group C was given simple cocktail therapy (hormone-containing); group D was given simple cocktail therapy (hormone-free). Visual analogue score (VAS) of patients at rest state for 2, 6, 12, 24, 48 and 72 h and at active state for 24, 48 and 72 h after operation in four groups, maximum flexion range of motion of knee joint at 2nd, 3rd, 4th and 5th day after operation, and postoperative adverse reactions were recorded. Results There were significant differences in VAS score and knee joint activity among the four groups (F=10.798, P<0.001; F=6.220, P=0.001; F=6.075, P=0.001). The VAS scores in groups A, B and C at rest and active state were significantly lower, and the range of motion of knee joint in groups A, B and C was significantly greater than those in group D (P<0.05 for all). The average VAS score in group C at rest was significantly higher than in group A, with a difference of 0.52 (P=0.005). Conclusion Cocktail therapy combined with epidural single low dose morphine showed stronger and more synergistic analgesic effect after TKA, which could better improve the knee joint functional activity after TKA. Under the conditions of no hormone contraindication and adverse reactions, it was suggested that glucocorticoid should be added to “cocktail” mixed analgesics.
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