全膝关节置换术后10%氯化钠加压冷敷与清水冷敷疗效对比
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摘要
目的:比较自制10%氯化钠加压冰袋与清水冰袋冷敷对全膝关节置换术(TKA)后患者镇痛、消肿、减少出血的作用。方法:选取我科2013年1月～2015年8月接受初次单侧全膝关节置换的89例患者,告知患者2种冷敷方法,根据患者的选择分为10%氯化钠加压冰袋组(44例)和清水冰袋组(45例),加压冰袋组采用自制加压冰袋进行冷敷,清水冰袋组采用清水冰袋进行冷敷,测量两组患者术后12、24、48、72 h患肢髌上、髌下5 cm周径并评估疼痛情况;记录术后24 h引流袋引流量。结果:加压冰袋组患者术后12、24、48、72 h疼痛评分均较清水冰袋组低,差异有统计学意义(P<0. 05);加压冰袋组髌上5 cm术后48、72 h肿胀程度优于清水冰袋组,差异有统计学意义(P<0. 05);加压冰袋组髌下5 cm术后12、24、48、72 h肿胀程度优于清水冰袋组,差异有统计学意义(P<0. 05);加压冰袋组较清水冰袋组平均术后24 h引流量减少(P<0. 05)。结论:自制10%氯化钠加压冰袋较清水冰袋更有助于减轻患者疼痛和早期患肢肿胀,减少术后出血,有利于术后康复锻炼。
Objective: To compare the effects of pressurized salt ice packs( 10% saline,PIP) with water ice packs( WIP) on relieving the pain,swelling and reducing postoperative bleeding in patients following total knee arthroplasty( TKA).Methods: Eighty-nine patients undergone primary unilateral TKA were included from January 2013 to August 2015,and divided into either PIP group( n = 44) or WIP group( n = 45) decided by the patients through informed consent.Visual analog scale( VAS) was used to evaluate knee pain.The girth was measured at 5 cm superior and inferior to the patella for the affected knee and pain scale was recorded at 12,24,48 and 72 h,respectively,after operation,and drainage volume within 24 h after surgery was recorded.Results: The VAS scoring was lower in PIP group than in WIP group at 12,24,48 and 72 h after TKA( P<0. 05).The swelling at 5 cm superior and inferior to the patella was better improved at 48 and 72 h as well as 12,24,48 and 72 h for the affected knee treated with PIP( all P<0. 05).Patients managed with PIP had lower postoperative drainage volume( P<0. 05).Conclusion: PIP is more effective than WIP on reducing the postoperative pain,swelling and bleeding in patients following total knee arthroplasty,and can contribute to early postoperative rehabilitation exercise.
Objective: To compare the effects of pressurized salt ice packs( 10% saline,PIP) with water ice packs( WIP) on relieving the pain,swelling and reducing postoperative bleeding in patients following total knee arthroplasty( TKA).Methods: Eighty-nine patients undergone primary unilateral TKA were included from January 2013 to August 2015,and divided into either PIP group( n = 44) or WIP group( n = 45) decided by the patients through informed consent.Visual analog scale( VAS) was used to evaluate knee pain.The girth was measured at 5 cm superior and inferior to the patella for the affected knee and pain scale was recorded at 12,24,48 and 72 h,respectively,after operation,and drainage volume within 24 h after surgery was recorded.Results: The VAS scoring was lower in PIP group than in WIP group at 12,24,48 and 72 h after TKA( P<0. 05).The swelling at 5 cm superior and inferior to the patella was better improved at 48 and 72 h as well as 12,24,48 and 72 h for the affected knee treated with PIP( all P<0. 05).Patients managed with PIP had lower postoperative drainage volume( P<0. 05).Conclusion: PIP is more effective than WIP on reducing the postoperative pain,swelling and bleeding in patients following total knee arthroplasty,and can contribute to early postoperative rehabilitation exercise.
引文
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[2] WONG J,ABRISHAMI A,EIBEHEIRY H,et al.Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty:a randomized,controlled trial[J]. J Bone Joint Surg Am,2010,92(15):2503-2513.
[3] KUO CC,LIN CC,LEE WJ,et al.Comparing the antiswelling and analgesic effects of three different ice pack therapy durations:a randomized controlled trial on cases with soft tissue injuries[J]. J Nurs Res,2013,21:186-194.
[4] MURGIER J,CASSARDASSAR X.Cryotherapy with dynamic intermittent compression for analgesia after anterior cruciate ligament reconstruction.Preliminary study[J]. Orthop Traumatol Surg Res,2014,100:309-312.
[5] DUELLMAN TJ,GAFFIGAN C,MILBRANDT JC,et al.Multi-modal,pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty[J].Orthopedics,2009,32:167.
[6]吕厚山.现代人工关节外科学[M].北京:人民卫生出版社,2006:75-78.
[7] ADIE S,KWAN A,NAYLOR JM,et al.Cryotherapy following total knee replacement[J]. Cochrane Database Syst Rev,2012,9:CD007911.
[8] MACEDO LB,JOSUE AM,MAIA PH,et al.Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold:randomised,controlled,clinical trial[J]. Physiotherapy,2015,101:155-160.
[9] FANG L,HUNG CH,WU SL,et al.The effects of cryotherapy in relieving postarthroscopy pain[J].J Clin Nurs,2012,21:636-643.
[10] BLOK J.Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures:A narrative review[J].Open Access J Sports Med,2010,1:105-113.
[11] OLIVEIRA SM,SILVA FM,RIESCO ML,et al.Comparison of application times for ice packs used to relieve perineal pain after normal birth:a randomised clinical trial[J]. J Clin Nurs,2012,21:3382-3391.
[12]邓宝贵,全小明.冷疗对全膝关节置换术后出血量、疼痛、肿胀及睡眠质量的影响[J].护理研究,2014,28(4):1311-1313.