骨科术后快速康复0..概要.pptVIP

1.创伤刺激2.神经损伤、炎性因子3.炎性因子影响 * 注： 对术前采取镇痛措施进行术后镇痛的66篇RCTs （3261位患者）进行荟萃分析；----患者随机分为5组，分别为术前实施硬膜外麻醉组、局麻组、NMDA组、NSAID组和阿片组，---- 评价指标包括术后最初24-48h患者的疼痛强度、镇痛药物总需求量以及给予首次补救镇痛药物的时间3项指标； 研究表明：术前预外周神经局部浸润和静脉注射NSAIDs可以减少镇痛药物需求量、延长首次补救镇痛药物的时间； 本实验证明：术前给予NSAIDs对于围手术镇痛临床获益明确（减少镇痛药物使用量以及延迟麻醉性镇痛药物给予时间） * What is the Role of NSAIDs in Pre-emptive Analgesia?  * 骨科常见疼痛的处理专家建议 * * Marianne就髋关节置换患者术中保温问题进行了研究，通过将术中体温提高0．5℃，结果发现术中失血量显著减少。 * * FTC：降主动脉血流速度（Velocity of biood fiow in the descending aorta） SV:每搏输出量(Stroke Volume） * Postoperative pain is still inadequately relieved despite substantial improvements in the knowledge of the mechanisms and treatment of pain [1]. Evidence suggests that inadequate relief of postoperative pain may result in harmful physiologic and psychologic consequences that lead to significant morbidity and mortality [2], which may delay recovery and the return to daily living [3]. In addition, the presence of postoperative symptoms, including pain, significantly contributes to patients’ dissatisfaction with their anesthesia and surgical experience [4]. Most importantly, it has been recognized that inadequately treated postoperative pain may lead to chronic pain, which is often misdiagnosed and neglected [5,6]. This article reviews the physiologic and psychologic consequences of inadequate pain relief, with an emphasis on chronic persistent postoperative pain. * 2011年，Henrik 等撰文《Why still in hospital after fast-track hip and knee arthroplasty? 》，即《为何膝/髋关节置换术后依旧无法尽早出院？》，探讨分析了影响骨科大手术后影响患者出院的因素。 他们的分析发现：疼痛、眩晕和全身乏力是影响患者出院的主要因素。 而疼痛，是骨科手术后延迟患者出院的第一因素！ * * Subacute pain and function after fast-track hip and knee arthroplasty. TKA患者在术后1个月步行时，52%报告了中度疼痛(VAS评分 30-59 mm)；16% 重度疼痛(VAS ≥60 mm) 。 这就强调出院后疼痛管理需要改善，骨科术后亚急性期疼痛尤其需要重视。 * Easily adoptable total joint arthroplasty program allows discharge home in two days. 加拿大Queen‘s University大学Kingston General Hospital医院，对200例行全关节置换术的患者进行了研究。其中常规治疗和ERAS组各100例。 结果发现： ERAS减少住院天数69小时（47小时 VS 116小时）； 减少阿片用量7.5