临床医学毕业论文连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分析.doc

《临床医学毕业论文连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分析.doc》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、毕业论文连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分fi2014年6月25日连续硬膜外阻滞用于全膝关节置换术前超前镇痛临床疗效分析作者：董江涛，陈百成，康书峰，邵徳成，门小茜，吕东海【摘要】［H的］评价全膝关节置换术前连续硬膜外阻滞的超前镇痛效果。［方法］将54例行单侧膝关节置换术的患者随机分成两组，实验组术前12h硬膜外置管输入罗哌卡因，对照组输入生理盐水，所有患者术屮采用全麻，术后48h内破膜外口控镇痛，比较两组患者术后不同时间点膝关节静息和活动VAS疼痛评分、不良反应发生率、屈膝90。的天数、静脉血栓的发生率、膝关节活动度及术后6个

2、月术膝慢性疼痛发生率。［结果］术后24h内膝关节静息和48h活动VAS疼痛评分、住院期间深部静脉血栓发牛率、屈膝达到90。的天数实验组均低于对照组（P0.05）；术后6个月、1年关节活动度试验组高于对照组（P0.05）；术后2d内不良反应发生率、术后6个月术膝慢性疼痛发生率试验组与对照组无差异（P0.05）。［结论］连续硬膜外阻滞作为全膝关节置换术的超前镇痛方式能减轻术后早期疼痛、降低术后并发症、增加关节活动度口无明显不良反应。【关键词】连续硬膜外阻滞；超前镇痛；全膝关节置换术；视觉模拟评分；关节活动度Abstract:［Objective］To

3、observetheeffectofpreemptiveanalgesiawithcontinuousepidualanesthesiaintotalkneearthroplasty.［Methods］Fifty-fourpatientswhoweretreatedinauthor"shospitalwererandomlyassignedintotwogroupswith27patientsineach.Onegroupwastreatedwith0.125%ropivacaine2ml/hthroughepidualcathetersince

4、12hoursbeforetheoperation.Theothergroupwasgivensalineatthesamerate.Allthepatientsreceivedgeneralanaesthesiaintheoperation.Theuseofpatientcontrolledanalgesia（PCA）withepidualanesthesiawasinitiated48hoursafteroperation.PCAwasusedasasupplementwhenthepatientscomldn，tbearthepain.Th

5、efollowingvariationswerecomparedbetweenthesetwogroups:visualanalogscore(VAS),theincidencesofcomplication,deepveinthrombosis(DVT),thetimeoftheabilitytoactivelyreach90degreekneeflexion,therangeofmotion(ROM)andthechronicpainafteroperation.[Results]Thefollowingvariationswerestati

6、sticallysignificantlylowerinropivacainegroupthanthatinthesalinegroup:VAS,DVT,thetimetoreach90degreekneeflextion,whileROM6monthsand1yearafteroperationweresignificanthighe匚Therewerenostatisticallysignificantdifferencesbetweengroupsintheincidenceofthesideeffectsduringthetwodaysa

7、ftertheoperationandthechronicpainforalongertime.[Conclusion]Preemptiveanalgesiawithcontinuousepidualanesthesiacanalleviatetheearlystageofthepainaftertotalkneearthroplasty,decreasetheincidenceofthecomplicationandincreasetherangofmotionwithoutobvioussideeffects.Keywords：continu

8、ousepidualanesthesia；preemptiveanalgesia；totalkneearthroplasty；VAS；R