老年全膝关节置换术患者疼痛管理的研究进展
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摘要
伴随医学诊疗、卫生保健水平提升及人类寿命延长,人口老龄化相关问题逐渐凸显,如膝关节退行性变患者逐渐增多,严重降低老年患者日常生活质量。每年全球约60万人行全膝关节置换术(TKA)治疗,已成为治疗中重度骨关节炎的重要方法,可实现纠正关节畸形、改善功能的目的。但手术治疗并非此类疾病治疗的终结,术后伴发疼痛及行动不便等问题给患者带来了巨大心理压力,阻碍术后康复。疼痛如能合理、有效控制,将减少疼痛刺激造成的机体应激反应和继发性器官功能障碍。因此,全膝关节置换术后疼痛控制已成为临床治疗的重点内容。本文就TKA术后疼痛机制及疼痛管理方法最新进展进行综述。
Accompanying medical diagnosis and treatment、improvement of health care level and prolongation of human life,issues related to population ageing are becoming more and more prominent,such as the gradual increase of patients with degenerative knee degeneration,seriously reduce the quality of daily life of elderly patients.Annual Total knee arthroplasty(TKA)treatment for approximately 600,000 people worldwide,has become an important method for the treatment of moderate to severe osteoarthritis,can be achieved to correct joint deformities,improve the function of the purpose.But surgical treatment is not the end of treatment for such diseases,postoperative problems such as pain and mobility have brought great psychological pressure to patients,obstruction of early recovery after surgery.Reasonable and effective control of analgesia will reduce the stress response and secondary organ dysfunction caused by pain stimulation.So,Pain control after TKA has become the key content of clinical treatment.In this paper,the recent progress of postoperative pain mechanism and pain management methods in TKA was reviewed.
Accompanying medical diagnosis and treatment、improvement of health care level and prolongation of human life,issues related to population ageing are becoming more and more prominent,such as the gradual increase of patients with degenerative knee degeneration,seriously reduce the quality of daily life of elderly patients.Annual Total knee arthroplasty(TKA)treatment for approximately 600,000 people worldwide,has become an important method for the treatment of moderate to severe osteoarthritis,can be achieved to correct joint deformities,improve the function of the purpose.But surgical treatment is not the end of treatment for such diseases,postoperative problems such as pain and mobility have brought great psychological pressure to patients,obstruction of early recovery after surgery.Reasonable and effective control of analgesia will reduce the stress response and secondary organ dysfunction caused by pain stimulation.So,Pain control after TKA has become the key content of clinical treatment.In this paper,the recent progress of postoperative pain mechanism and pain management methods in TKA was reviewed.
引文
1 蔡松涛.全膝关节置换术后肌力训练对膝关节功能的影响分析[J].中国实用医药,2014,9(21):103-103.
2 Lewis C,Gunta K,Mitchell K,et al.Effectiveness of multimodal pain management protocol in total knee arthroplasty patients[J].Orthop Nurs,2012,31(3):153-159.
3 陈昼琳,於挺.阿片受体-阿片肽的免疫镇痛效果及价值研究[J].医学信息,2015,28(6):207.
4 Beck A,Salem K,Krischak G,et al.Nonsteroidal anti-inflammatory drugs(NSAIDs)in the perioperative phase in traumatology and orthopedics effects on bone healing[J].Oper Orthop Traumatol,2005,17(6):569-578.
5 Adam F,Chauvin M,Du Manoir B,et al.Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty[J].Anesth Analg,2005,100(2):475-480.
6 Buvanendran A,Kroin JS,Della Valle CJ,et al.Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty:A prospective,randomized,controlled trial[J].Anesth Analg,2010,110(1):199-207.
7 单海华,朱常花,谢红,等.超声引导下罗哌卡因连续股神经阻滞用于20例全膝关节置换术后康复镇痛的疗效分析[J].重庆医学,2012,41(13):1312-1314.
8 Rathmell JP,Pino CA,Taylor R,et al.Intrathecal morphine for postoperative analgesia:A randomized,controlled,dose-ranging study after hip and knee arthroplasty[J].Anesth Analg,2003,97(5):1452-1457.
9 Harsten A,Kehlet H,Toksvig-Larsen S.Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty[J].Survey of Anesthesiology,2014,58(1):54.
10 Wang AZ,Gu LL,Zhou QH,et al.Ultrasound-guided continuous femoral nerve block for analgesia after total knee arthroplasty:Catheter perpendicular to the nerve versus catheter parallel to the nerve[J].Reg Anesth Pain Med,2010,35(2):127-131.
11 Ben SF,Gollish J,Haslam L,et al.Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty:A prospective,randomized,double-blinded,controlled trial[J].J Arthroplasty,2014,29(6):1149-1153.
12 Wanich T,Gelber J,Rodeo S,et al.Percutaneous neuromodulation pain therapy following knee replacement[J].J Knee Surg,2011,24(3):197-202.
13 Hartrick CT,Martin G,Kantor G,et al.Evaluation of a single-dose,extended-release epidural morphine formulation for pain after knee arthroplasty[J].J Bone Joint Surg Am,2006,88(2):273-281.
14 饶世鸣,蒋乐佩,郑文娴,等.持续性生物冰袋冷敷在全膝关节置换术后减轻关节肿痛的研究[J].现代实用医学,2010,22(7):821-822.
15 赵丽君.全膝关节置换术实施个体化整体化护理的价值[J].浙江临床医学,2015,17(2):327-328.
16 冯永建,金驰,倪永健,等.虚拟现实技术对全膝关节置换术后功能恢复及心理改善的作用[J].中华骨与关节外科杂志,2018,11(2):127-132.
17 孙春红.耳穴贴压减轻膝关节术后疼痛的临床观察[J].中国中医急症,2013,22(12):2098-2099.
18 童培建,汪海东,马镇川,等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9):931-934.
19 Petersen SL,Botes C,Olivier A,et al.The effect of low level laser therapy(LLLT)on wound healing in horses[J].Equine Vet J,1999,31(3):228-231.
20 周燕芸,黄小玲,吴凤莺.威伐光辅助治疗对全膝关节置换术切口愈合的效果及护理[J].福建医药杂志,2015,37(3):135-136.
21 孙庆山,王芳,林永杰,等.多模式镇痛结合分阶段康复治疗对全膝置换术后功能恢复的疗效观察[J].中国康复医学杂志,2018,33(3):352-354.
22 陆慧红,李桂凤,白浪,等.全膝关节置换后局部浸润的持续镇痛效果[J].中国组织工程研究,2014,18(4):529-534.
23 杨学伟,耿立成,张军,等.全膝关节置换术围术期多模式镇痛的临床研究[J].医学信息,2013,26(26):218-218,219.
24 包良笑,史占军,李婧,等.个案管理模式在人工髋膝关节置换患者疼痛管理中的应用[J].中国急救医学,2017,37(z1):53-54.
25 付丽敏,杨小华,吕永明,等.加速康复外科在全膝置换患者康复治疗中的应用[J].中国组织工程研究与临床康复,2011,15(22):4019-4022.
2 Lewis C,Gunta K,Mitchell K,et al.Effectiveness of multimodal pain management protocol in total knee arthroplasty patients[J].Orthop Nurs,2012,31(3):153-159.
3 陈昼琳,於挺.阿片受体-阿片肽的免疫镇痛效果及价值研究[J].医学信息,2015,28(6):207.
4 Beck A,Salem K,Krischak G,et al.Nonsteroidal anti-inflammatory drugs(NSAIDs)in the perioperative phase in traumatology and orthopedics effects on bone healing[J].Oper Orthop Traumatol,2005,17(6):569-578.
5 Adam F,Chauvin M,Du Manoir B,et al.Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty[J].Anesth Analg,2005,100(2):475-480.
6 Buvanendran A,Kroin JS,Della Valle CJ,et al.Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty:A prospective,randomized,controlled trial[J].Anesth Analg,2010,110(1):199-207.
7 单海华,朱常花,谢红,等.超声引导下罗哌卡因连续股神经阻滞用于20例全膝关节置换术后康复镇痛的疗效分析[J].重庆医学,2012,41(13):1312-1314.
8 Rathmell JP,Pino CA,Taylor R,et al.Intrathecal morphine for postoperative analgesia:A randomized,controlled,dose-ranging study after hip and knee arthroplasty[J].Anesth Analg,2003,97(5):1452-1457.
9 Harsten A,Kehlet H,Toksvig-Larsen S.Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty[J].Survey of Anesthesiology,2014,58(1):54.
10 Wang AZ,Gu LL,Zhou QH,et al.Ultrasound-guided continuous femoral nerve block for analgesia after total knee arthroplasty:Catheter perpendicular to the nerve versus catheter parallel to the nerve[J].Reg Anesth Pain Med,2010,35(2):127-131.
11 Ben SF,Gollish J,Haslam L,et al.Comparing the effects of single shot sciatic nerve block versus posterior capsule local anesthetic infiltration on analgesia and functional outcome after total knee arthroplasty:A prospective,randomized,double-blinded,controlled trial[J].J Arthroplasty,2014,29(6):1149-1153.
12 Wanich T,Gelber J,Rodeo S,et al.Percutaneous neuromodulation pain therapy following knee replacement[J].J Knee Surg,2011,24(3):197-202.
13 Hartrick CT,Martin G,Kantor G,et al.Evaluation of a single-dose,extended-release epidural morphine formulation for pain after knee arthroplasty[J].J Bone Joint Surg Am,2006,88(2):273-281.
14 饶世鸣,蒋乐佩,郑文娴,等.持续性生物冰袋冷敷在全膝关节置换术后减轻关节肿痛的研究[J].现代实用医学,2010,22(7):821-822.
15 赵丽君.全膝关节置换术实施个体化整体化护理的价值[J].浙江临床医学,2015,17(2):327-328.
16 冯永建,金驰,倪永健,等.虚拟现实技术对全膝关节置换术后功能恢复及心理改善的作用[J].中华骨与关节外科杂志,2018,11(2):127-132.
17 孙春红.耳穴贴压减轻膝关节术后疼痛的临床观察[J].中国中医急症,2013,22(12):2098-2099.
18 童培建,汪海东,马镇川,等.耳穴疗法在全膝关节置换围手术期镇痛的应用及疗效观察[J].中国中西医结合杂志,2010,30(9):931-934.
19 Petersen SL,Botes C,Olivier A,et al.The effect of low level laser therapy(LLLT)on wound healing in horses[J].Equine Vet J,1999,31(3):228-231.
20 周燕芸,黄小玲,吴凤莺.威伐光辅助治疗对全膝关节置换术切口愈合的效果及护理[J].福建医药杂志,2015,37(3):135-136.
21 孙庆山,王芳,林永杰,等.多模式镇痛结合分阶段康复治疗对全膝置换术后功能恢复的疗效观察[J].中国康复医学杂志,2018,33(3):352-354.
22 陆慧红,李桂凤,白浪,等.全膝关节置换后局部浸润的持续镇痛效果[J].中国组织工程研究,2014,18(4):529-534.
23 杨学伟,耿立成,张军,等.全膝关节置换术围术期多模式镇痛的临床研究[J].医学信息,2013,26(26):218-218,219.
24 包良笑,史占军,李婧,等.个案管理模式在人工髋膝关节置换患者疼痛管理中的应用[J].中国急救医学,2017,37(z1):53-54.
25 付丽敏,杨小华,吕永明,等.加速康复外科在全膝置换患者康复治疗中的应用[J].中国组织工程研究与临床康复,2011,15(22):4019-4022.