吗啡关节周围联合药物注射和鞘内注射对人工全膝关节置换术后疼痛和关节功能的影响

目的 比较吗啡关节周围联合药物注射（PMDI）和鞘内注射对人工全膝关节置换术（TKA）患者术后疼痛和关节功能的影响。方法 回顾分析我院行TKA患者153例,按照麻醉方式分成对照组、PMDI组和鞘内注射组,每组51例。对照组患者接受常规腰麻及关节周围软组织注射,PMDI组患者关节周围额外注射10 mg盐酸吗啡注射液,鞘内注射组患者腰麻药物中额外加入0.1 mg盐酸吗啡注射液。记录三组患者术后疼痛视觉模拟量表（VAS）评分。记录三组患者术后追加曲马多用量和首次追加曲马多时间。记录三组患者术后患肢主动关节屈曲角度。记录三组患者术后呕吐次数和术后止呕药物使用次数。结果 术后6、12和24 h PMDI组和鞘内注射组患者术后疼痛VAS评分显著低于对照组患者（P<0.05）,术后6、12和24 h鞘内注射组患者术后疼痛VAS评分显著低于PMDI组患者（P<0.05）。术后12 h和24 h PMDI组和鞘内注射组患者追加曲马多用量显著低于对照组患者（P<0.05）,术后12 h和24 h 鞘内注射组患者追加曲马多用量显著低于PMDI组患者（P<0.05）。PMDI组和鞘内注射组患者术后首次追加曲马多时间显著低于对照组患者（P<0.05）,鞘内注射组患者术后首次追加曲马多时间显著低于PMDI组患者（P<0.05）。术后12 h和24 h PMDI组和鞘内注射组患者术后患肢主动关节屈曲角度显著高于对照组患者（P<0.05）,术后12 h和24 h 鞘内注射组患者术后患肢主动关节屈曲角度显著高于PMDI组患者（P<0.05）。术后12 h、24 h和48 h PMDI组和鞘内注射组患者术后呕吐次数和术后止呕药物使用次数显著高于对照组患者（P<0.05）,术后12 h、24 h和48 h PMDI组患者术后呕吐次数和术后止呕药物使用次数显著高于鞘内注射组患者（P<0.05）。结论 吗啡PMDI和吗啡Ⅱ均为有效的TKA术后镇痛方法,其中吗啡Ⅱ较吗啡PMDI可进一步缓解TKA术后患者疼痛,加快患者早期关节功能恢复。但吗啡PMDI和吗啡Ⅱ均会增加TKA术后呕吐发生率,需要临床医生重视。

Comparison of effect of morphine periarticular multimodal drug injection and intrathecal injection on pain and join function after total knee arthroplasty

Objective To compare the effect of morphine periarticular multimodal drug injection （PMDI） and intrathecal injection on pain and join function after total knee arthroplasty （TKA）. Methods 153 received TKA patients were retrospectively analyzed and assigned to the control group, PMDI group and intrathecal injection group （n=51）. Patients in the control group received regular spinal anesthesia and PMDI. Patients in the PMDI group received morphine 10 mg PMDI, and patients in the intrathecal injection group received morphine 0.1 mg intrathecal injection. Patients' visual analog scale （VAS） pain scores, tramadol usage, first using tramadol time, range of active knee flexion, vomiting times, usage of anti-nausea drugs were recorded postoperatively. Results VAS pain scores were significantly lower in the PMDI group and the intrathecal injection group than those in the control group in postoperative 6, 12 and 24 h （P<0.05）, and they were significantly lower in the intrathecal injection group than those in the PMDI group （P<0.05）. Tramadol usages were significantly lower in the PMDI group and the intrathecal injection group than those in the control group in postoperative 12 and 24 h （P<0.05）, and they were significantly lower in the intrathecal injection group than those in the PMDI group （P<0.05）. The first using tramadol time was significantly lower in the PMDI group and the intrathecal injection group than that in the control group （P<0.05）, and it was significantly lower in the intrathecal injection group than that in the PMDI group （P<0.05）. The ranges of active knee flexion were significantly larger in the PMDI group and the intrathecal injection group than those in the control group in postoperative 12 and 24 h （P<0.05）, and they were significantly larger in the intrathecal injection group than those in the PMDI group （P<0.05）. Vomiting times and usages of anti-nausea drugs were significantly more than those in the control group in postoperative 12, 24 and 48 h （P<0.05）, and they were significantly more in the PMDI group than those in the intrathecal injection group （P<0.05）. Conclusion Morphine PMDI and Ⅱ are both effective analgesic methods, and morphine Ⅱ is more effective in relieving postoperative pain and increasing knee function than morphine PMDI. However, morphine PMDI and Ⅱ both could increase the incidence rate of vomiting after TKA, which needs more attention from doctors.