冷疗、耳穴联合多模式镇痛对全膝关节置换术后康复效果的临床研究
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摘要
目的:比较结合冷疗和耳穴的多模式镇痛对全膝关节置换术(TKA)后康复的疗效。方法:经伦理委员会批准,样本量估算,以笔者所在医院收治的20例膝骨关节炎患者作为研究对象,将其随机分为试验组和对照组各10例,比较术后6 h、24 h、48 h、7 d、14 d疼痛程度(VAS评分)和关节活动度,以及隐性失血量。结果:两组术后6、24 h的VAS评分比较差异无统计学意义(P>0.05);试验组术后48 h、7 d、14 d的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组术后6、24、48 h关节活动度比较差异无统计学意义(P>0.05);试验组在术后7、14 d关节活动度均高于对照组,差异均有统计学意义(P<0.05)。试验组患者隐性失血量低于对照组,差异均有统计学意义(P<0.05)。结论:结合冷疗、耳穴的多模式镇痛,能显著减少术后隐性失血量,减少术后关节肿胀、疼痛,改善术后ROM,操作简易,具有很高的临床应用价值。
Objective:To compare the effects of multimodal analgesia combined with cold therapy and auricular acupoints on rehabilitation after total knee arthroplasty.Method:According to the ethics committee approval and sample size estimation,20 patients with knee osteoarthritis admitted to our hospital were randomly divided into the experimental group and the control group,10 cases in each group.The pain level(VAS score),joint mobility,the hidden blood loss were compared at 6 h,24 h,48 h,7 d,14 d after surgery were compared.Result:There were no significant differences in VAS score between the two groups at 6 h,24 h after operation(P>0.05),but the VAS score at 48 h,7 d and 14 d after operation in the experimental group were significantly lower than those in the control group(P<0.05).There were no significant differences in joint motion between the two groups at 6 h,24 h and 48 h after operation(P>0.05).The range of motion of the experimental group higher than those of the control group at 7 d and 14 d after operation,and the differences were statistically significant(P<0.05).The hidden blood loss in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Multimodal analgesia combined with cold therapy and auricular acupoints,can significantly reduce the hidden blood loss,joint swelling and pain,improve ROM.It is easy to operate and has high clinical value.
Objective:To compare the effects of multimodal analgesia combined with cold therapy and auricular acupoints on rehabilitation after total knee arthroplasty.Method:According to the ethics committee approval and sample size estimation,20 patients with knee osteoarthritis admitted to our hospital were randomly divided into the experimental group and the control group,10 cases in each group.The pain level(VAS score),joint mobility,the hidden blood loss were compared at 6 h,24 h,48 h,7 d,14 d after surgery were compared.Result:There were no significant differences in VAS score between the two groups at 6 h,24 h after operation(P>0.05),but the VAS score at 48 h,7 d and 14 d after operation in the experimental group were significantly lower than those in the control group(P<0.05).There were no significant differences in joint motion between the two groups at 6 h,24 h and 48 h after operation(P>0.05).The range of motion of the experimental group higher than those of the control group at 7 d and 14 d after operation,and the differences were statistically significant(P<0.05).The hidden blood loss in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion:Multimodal analgesia combined with cold therapy and auricular acupoints,can significantly reduce the hidden blood loss,joint swelling and pain,improve ROM.It is easy to operate and has high clinical value.
引文
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[14]刘晓雅,岳宗进,孙永强.中西医协同镇痛方案在人工膝关节置换围手术期的临床疗效观察[J].中国矫形外科杂志,2012,20(21):1953-1956.
[15]王庆全,陈豫,朱蕾,等.耳穴压豆联合硫酸吗啡缓释片治疗癌痛60例[J].中医外治杂志,2016,25(4):18-19.
[16]陆晓峰,唐秀琴,周倩妮,等.中医外治法对癌痛“三阶梯止痛”疗法中副作用的干预效果观察[J].中医临床研究,2015,7(25):66-68.
[17]Willer J C,Roby A,Le Bars D.Psychophysical and electrophysiological approaches to the pain-relieving effects of heterotopic nociceptive stimuli[J].Brain,1984,107(4):1095-1112.
[18]Sandkuhler J.The organization and function of endogenous antinociceptive systems[J].Prog Neurobiol,1996,50(1):49-81.
[19]孙国杰.针灸学[M].上海:上海科学技术出版社,1997:194-207.
[20]赵远莲,肖庆帮,蒋智钢,等.不同冰敷方式对急性闭合性软组织损伤处理效果的影响[J].中国现代医学杂志,2016,26(20):1-5.
[21]任雪玲.自制新型冰敷固定带用于人工全髋关节置换术后冰敷的效果观察[J].中国卫生标准管理,2017,8(20):178-180.
[22]Pan L,Hou D,Liang W,et al.Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty[J].Int J Clin Exp Med,2015,8(10):18179-18184.
[2]Vos T,Flaxman A D,Naghavi M,et al.Years lived with disability(YLDs)for 1160 sequelae of 289 diseases and injuries 1990-2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2163-2196.
[3]宣华兵,罗新乐,唐久阳,等.全膝关节置换治疗膝关节骨关节炎[J/OL].中华关节外科杂志:电子版,2018,10(3):338-343.
[4]Bourne R B,Chesworth B M,Davis A M,et al.Patient satisfaction after total knee arthroplasty:who is satisfied and who is not?[J].Clin Orthop Relat Res,2010,468(1):57-63.
[5]Morone N E,Weiner D K.Pain as the fifth vital sign:exposing the vital need for pain education[J].Clin Ther,2013,35(11):1728-1732.
[6]Wiesmann T,Piechowiak K,Duderstadt S,et al.Continuous adductor canal block versus continuous femoral nerve block after total knee arthroplasty for mobilisation capability and pain treatment:a randomised and blinded clinical trial[J].Arch Orthop Trauma Surg,2016,136(3):397-406.
[7]史斌,安静,陈龙刚,等.人工膝关节置换术后疼痛影响因素的分析[J].中国组织工程研究,2017,21(7):993-997.
[8]何炎鸿,薛建军,杨小霞.TKA中医镇痛方法概述[J].现代中医药,2017,37(2):86-88.
[9]黄子达,张文明,李文波,等.氨甲环酸减少人工全膝关节置换术后失血量的自身对照研究[J].中国修复重建外科杂志,2015,29(3):280-283.
[10]尹卫娟,蔡靓羽,张建楠,等.耳穴压丸联合股神经阻滞在膝关节置换术后镇痛的应用[J].临床麻醉学杂志,2015,31(12):1238-1239.
[11]Gross J B.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-280.
[12]窦哲,杨云,黄健.全膝关节置换围手术期的镇痛:措施与对策[J].中国组织工程研究,2018,22(23):3716-3722.
[13]Kehlet H,Dahl J B.The value of“multimodal”or“balanced analgesia”in postoperative pain treatment[J].Anesth Analg,1993,77(5):1048-1056.
[14]刘晓雅,岳宗进,孙永强.中西医协同镇痛方案在人工膝关节置换围手术期的临床疗效观察[J].中国矫形外科杂志,2012,20(21):1953-1956.
[15]王庆全,陈豫,朱蕾,等.耳穴压豆联合硫酸吗啡缓释片治疗癌痛60例[J].中医外治杂志,2016,25(4):18-19.
[16]陆晓峰,唐秀琴,周倩妮,等.中医外治法对癌痛“三阶梯止痛”疗法中副作用的干预效果观察[J].中医临床研究,2015,7(25):66-68.
[17]Willer J C,Roby A,Le Bars D.Psychophysical and electrophysiological approaches to the pain-relieving effects of heterotopic nociceptive stimuli[J].Brain,1984,107(4):1095-1112.
[18]Sandkuhler J.The organization and function of endogenous antinociceptive systems[J].Prog Neurobiol,1996,50(1):49-81.
[19]孙国杰.针灸学[M].上海:上海科学技术出版社,1997:194-207.
[20]赵远莲,肖庆帮,蒋智钢,等.不同冰敷方式对急性闭合性软组织损伤处理效果的影响[J].中国现代医学杂志,2016,26(20):1-5.
[21]任雪玲.自制新型冰敷固定带用于人工全髋关节置换术后冰敷的效果观察[J].中国卫生标准管理,2017,8(20):178-180.
[22]Pan L,Hou D,Liang W,et al.Comparison the effects of pressurized salt ice packs with water ice packs on patients following total knee arthroplasty[J].Int J Clin Exp Med,2015,8(10):18179-18184.