膝关节局部注药在全膝关节置换镇痛中的应用_论文.docxVIP

PAGE7 / NUMPAGES7 膝关节局部注药在全膝关节置换镇痛中的应用  作者：高正玉，王英振，徐红梅，王昌耀 ，吴继霞  【摘要】 ［目的］研究全膝关节置换(total knee arthroplasty，TKA)术中关节周围注射罗哌卡因、酮洛酸氨丁三醇、肾上腺素混合药物，联合术后关节腔内注射罗哌卡因、酮洛酸氨丁三醇对TKA的镇痛效果、术后康复的影响及副作用。［方法］选择在本院行单侧TKA的50例患者随机分为两组，研究组术中将罗哌卡因、酮洛酸氨丁三醇、肾上腺素的混合液注射在膝关节周围，术后48 h拔除引流管后，关节腔内注入罗哌卡因、酮洛酸氨丁三醇。对照组术中、术后均给予相同剂量的生理盐水作为对照。记录视觉模拟评分（VAS）、Rameasay镇静评分，CPM膝关节活动度及副作用，应用统计软件SPSS 进行统计学分析。［结果］研究组术后6、12、24 h，第3、4 d的VAS评分均低于对照组，（t=～，P＜），第2 d时VAS评分无差别（t=，P＞），CPM膝关节活动度在术后2～6 d高于对照组（t=～，P＜），而在第7 d以后活动度无差别（t=～，P＞）。两组副作用无差别（x2值，P＞）。［结论］TKA术中关节周围注药联合术后关节腔内注药可在术后早期减轻疼痛、改善关节活动度、促进康复，且不会增加副作用。  【关键词】 人工假体； 全膝关节； 局部注药； 镇痛  Abstract: ［Objective］To investigate the analgesia effect, the influence on rehabilitation and side effect of ropivacaine, ketorolac tromethamine, epinephrine during the total knee arthroplsaty(TKA) combined with intra-articular injection of ropivacaine and ketorolac tromethamine after TKA. ［Methods］Fifty patients who underwent unilateral TKA from November 2017 to July 2017 were randomly divided into two study group received periarticular injection of ropivacaine ,ketorolac tromethamine and epinephrine at operation combined with inrta-articular injection of ropivacaine and ketorolac tromethamine after control group received the same dosage of normal saline at operation and after ,Rameasay sedation score ,the range of CPM exercises of the knee and side effect were recorded, respectively. SPSS was used to analyze the data.［Results］At 6、12、24 hour,3 and 4 days ,VAS in study group was lower than that in control group （t=～，P＜）,but there was no difference at 2 days between the two groups（t=，P＞）. The range of CPM exercises of the knee was higher in the study group that in than in the control group at 2～6 days（t=～，P＜）,but no difference was noted at 7 days（t=～,P＞）. The incidence of side effect was not different between 2 groups （x2=，P＞）.［Conclusion］Periarticular drug injection during TKA and intra-articular drug injection after operation can relieve pain early after