论文部分内容阅读
[目的]探讨人工全膝关节置换术后,鸡尾酒局部镇痛对患者皮温及术后疼痛评分的影响以及膝关节皮温变化曲线的意义.[方法] 2015年10月～2016年6月收集78例拟行初次单侧人工全膝关节置换术的膝骨性关节炎患者,随机分为鸡尾酒组与常规组,每组39例.鸡尾酒组患者术中膝关节周围注射鸡尾酒式镇痛药物并采用分段阻滞,即术野显露时及关闭关节囊前分别注射鸡尾酒25 ml,而常规组术中不做任何处理.所有患者术前术后处理方案均一致.比较两组术后4、8、12h静息时及术后24、48、72 h活动时疼痛视觉模拟评分(visual analogue scale,VAS)、双侧膝关节皮温、膝关节最大被动活动度(range of motion,ROM)以及术后追加止痛药的情况.[结果]鸡尾酒组的VAS评分显著低于常规组(P＜0.05);术后1周ROM均优于常规组;鸡尾酒组双侧平均皮湿在前3d较常规组有所降低,且术后第5～7 d两组患者膝关节皮温差达到峰值.[结论]鸡尾酒镇痛能够降低全膝关节置换术后膝关节局部皮温和疼痛,显著提高了患者术后活动度.皮温作为一个较VAS评分更加客观的指标可能术后炎症控制方面有着独到的作用.“,”[Objective] To evaluate the effects of the cocktail local analgesia on knee skin temperature,pain scores and ROM after primary total knee arthroplasty (TKA) and aim to estabhsh the pattern of postoperative knee skin temperature which can be used to improve the diagnostic rate of early prosthesis infection.[Methods] From October 2015 to June 2016,78 patients who underwent TKA were selected and randomly divided into the cocktail group and the conventional group.The patients of the cocktail group received local injection of 25ml cocktail drugs,which was mixture of 0.75％ ropivacaine hydrochloride (150 mg),0.1％ epinephrine (0.1ing) and 3％ ketorolac tromethamine (30mg),at the exposure of surgical field and before the closure of joint capsule respectively,whereas the patients in the conventional group had no any local injection.Visual analogue scales (VAS),knee skin temperature,range of motion (ROM) and supplemental analgesic drugs were recorded and compared between two groups.[Results] The patients in the cocktail group had lower pain VAS score after TKA compared with the conventional group(P＜0.05).The skin temperature both on the operated and contralateral knees rose up compared to preoperative states,especially on the operated sides,and remained elevated up to 3 months after surgery.The skin temperature in bilateral knees in the cocktail group was lower than that of the conventional group at first 3 days after TKA,and the difference between two groups reached to a peak at 5-7 days postoperatively.Consistently,the ROM of the cocktail group was significantly better than that of the conventional group at 1 week after operation (P＜0.05).[Conclusions] The cocktail local analgesia in TKA patients achieves satisfactory outcome to decrease local temperature with better functional recovery.Skin temperature,a more objective indicator than VAS,might play a role in inflammation control and infection prevention.