氟比洛芬酯联合盐酸曲马多片剂用于全膝关节置换术围手术期镇痛的疗效

目的 评价全膝关节置换术后采取氟比洛芬酯联合曲马多的术后镇痛效果.方法 将48例行单侧全膝关节置换术的患者随机分成2组各24例.试验组（A组）术前晚给予盐酸曲马多片剂0.1mg口服,术后回房即开始应用氟比洛芬酯50g,8h后给予盐酸曲马多片剂0.1mg;对照组（B组）输注生理盐水＋安慰剂.患者术中均采用全身麻醉,术后不应用镇痛泵自控镇痛.比较2组术后不同时间点膝关节静息痛和活动痛视觉模拟评分（visual analog score,VAS）、不良反应发生率、屈膝90°的时间、膝关节活动度.结果 ①试验组术后12、24、48、72h静息痛及术后24、48、72h活动痛VAS均低于对照组,差异有统计学意义（P＜0.05）;②术后第2天内不良反应发生率试验组与对照组差异无统计学意义（P＞0.05）;③术后屈膝达到90°的时间试验组短于对照组,差异有统计学意义（P＜0.05）;④术后3、6个月膝关节运动范围数值试验组高于对照组,差异有统计学意义（P＜0.05）.结论 全膝关节置换术后应用氟比洛芬酯联合盐酸曲马多片剂能减轻术后早期疼痛,降低术后并发症且无明显不良反应,并对患肢远期恢复有益处.

EFFICACY OF FLURBIPROFEN AXETIL COMBINED WITH TRAMADOL HYDROCHLORIDE HYDROCHLORIDE TABLETS IN PERIOPERATIVE ANALGESIA FOR TOTAL KNEE ARTHROPLASTY

Objective To observe the effect of flurbiprofen axetil with tramadol hydrochloride sustained-release tablets in total knee arthroplasty.Methods Forty-eight patients who were treated with unilateral total knee arthroplasty in Langfang Fourth People＇s Hospital were enrolled and randomly assigned into two groups：experimental group and control group,24 patients in each group.The experimental group used flurbiprofen axetil 50 mg with tramadol hydrochloride sustained-release tablets 0.1 mg after operation.The control group used physiological saline with placebo after the operation,all the patients received general anaesthesia during the operation.Comparison was performed on the pain level at different times after the operation which were rated by visual analog score （VAS）,the incidences of complication,the time of the ability to actively reach 90 degree knee flexion,the condition of the knee movement.Results ①The VAS at the time of 12,24,48,72h afteroperation when at rest and 24,48,72h when at movement was significant lower in experiment group （P ＜ 0.05）.②There was no significant difference between the two groups in the incidence of the side effects during the two days after the operation （P ＞ 0.05）.③The number of days reaching 90 degree flexion was significantly shorter in group A（P ＜0.05）.④The range of motion 3 months or 6months after operation was significantly better in experiment group （P ＜ 0.05）.Conclusion Flurbiprofen axetil with tramadol hydrochloride sustainedrelease tablets can alleviate the early stage of the pain after total knee arthroplasty,decrease the incidences of the complication and have no obvious side effects.As a result,it can encourage early participation in rehabilitation program.