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摘要:
目的 比较有/无糖尿病的膝关节骨关节炎(knee osteoarthritis, KOA)患者关节置换术后急性疼痛的差异。 方法 前瞻性收集并分析2017年10月至2018年2月在首都医科大学附属北京朝阳医院行单侧全膝关节置换术(total knee arthroplasty, TKA)患者的临床资料。依据是否合并糖尿病，分为糖尿病组和非糖尿病组。两组患者均采用蛛网膜下腔麻醉联合单次股神经阻滞麻醉，术后均采用经静脉患者自控镇痛(patient controlled intravenousanalgesia, PCIA)，若静息状态下视觉模拟评分(visual analogue scale, VAS)＞4分时，则口服羟考酮5 mg镇痛。比较两组术前及术后4 h、1 d、2 d、3 d、4 d、5 d静息/运动状态VAS评分及术后不同时间点镇痛泵内药物用量、口服羟考酮剂量。记录PCIA使用期间不良反应发生情况。 结果 共117例符合纳入和排除标准的KOA患者入选本研究，其中糖尿病组49例、非糖尿病组68例。两组患者术前及术后4 h、1 d静息/运动状态VAS评分差异无统计学意义(P均＞0.05)，糖尿病组术后2、3、4、5 d静息/运动状态VAS评分明显高于非糖尿病组(P均＜0.05)。两组患者术后4 h内镇痛泵用药量、术后1 d口服羟考酮剂量差异无统计学意义(P均＞0.05)，糖尿病组术后2、3、4、5 d口服羟考酮剂量及术后24、48 d内镇痛泵用药量多于非糖尿病组(P均＜0.05)。两组PCIA使用期间恶心呕吐、头晕发生率无统计学差异(P均＞0.05)。 结论 糖尿病可加剧KOA患者TKA术后(术后2~5 d)急性疼痛，增加早期阿片类镇痛药物的使用量。 Abstract:Objective To compare the difference of acute pain after joint replacement in patients with knee osteoarthritis (KOA) with or without diabetes. Methods Clinical data of patients with total knee arthroplasty (TKA) who underwent surgery at Beijing Chaoyang Hospital, Capital Medical University from October 2017 to February 2018 were prospectively collected and analyzed. They were divided into the diabetes group and the non-diabetes group according to whether they had diabetes or not. Patients of the two groups were given subarachnoid anesthesia combined with single femoral nerve block anesthesia. After the operation, patient controlled intravenousanalgesia (PCIA) was applied. If the visual analogue scale (VAS) score exceeded 4 in the resting state, the patients would take 5 mg of Oxycodone analgesia orally. VAS scores of resting pain/exercise pain, drug dosage in postoperative analgesia pump, and oral oxycodone dose were compared between the two groups before, 4 h, 1 d, 2 d, 3 d, 4 dand 5 d after the operation. The occurrence of adverse reactionsduring the use of narcotic drugs was recorded. Results A total of 117 KOA patients meeting the inclusion and exclusion criteria were included in this study, including 49 in the diabetic group and 68 in the non-diabetic group. VAS scores of rest pain/exercise pain were not significantly different between the two groups before, 4 h, and 1 d after the operation (all P > 0.05). VAS scores of rest pain/exercise pain were significantly higher in the diabetic group than in the non-diabetic group 2 d, 3 d, 4 d, and 5 d after the operation (all P < 0.05). There was no statistically significant difference between the two groups in term of the dosage of analgesia pump 4 h after the operation and the dosage of oral oxycodone 1 d after the operation (all P > 0.05). The dosage of oral oxycodone 2 d, 3 d, 4 d and 5 d after the operation and the dosage of oral oxycodone 24 h and 48 h after the operation of the diabetes group were higher than that of the non-diabetes group (all P < 0.05). There was no statistical difference in the incidence of nausea, vomiting, and dizziness during applying PCIA between the two groups (all P > 0.05). Conclusion Diabetes can aggravate acute pain in KOA patients after TKA (2-5 d after TKA) and increase the use of opioid analgesics in the early stage. -
Key words:
- knee arthroplasty /
- knee osteoarthritis /
- diabetes /
- acute pain
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表 1 糖尿病组与非糖尿病组患者一般资料比较
指标 糖尿病组(n=49) 非糖尿病组(n=68) P值 男性[n(%)] 10(20.4) 15(22.1) 0.830 年龄($\bar x \pm s$, 岁) 67.18±6.56 66.24±7.79 0.489 体质量指数($\bar x \pm s$, kg/m2) 27.60±3.49 25.99±3.60 0.017 术前血糖($\bar x \pm s$, mmol/L) 7.57±1.73 5.15±0.49 ＜0.001 术前HbA1c($\bar x \pm s$, %) 7.00±0.88 5.55±0.44 ＜0.001 手术时间($\bar x \pm s$, min) 77.08±16.55 74.59±19.60 0.471 
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表 2 糖尿病组与非糖尿病组患者术后不同时间点静息状态下VAS评分比较
($\bar x \pm s$，分) 组别 术前 术后4 h 术后1 d 术后2 d 术后3 d 术后4 d 术后5 d 糖尿病组(n=49) 3.6±2.1 0.7±0.5 3.6±1.7 5.6±2.0* 4.5±2.4# 3.2±1.6# 2.8±1.5# 非糖尿病组(n=68) 3.1±1.9 0.7±0.6 3.2±2.0 4.3±2.0 2.5±1.7 1.6±1.3 1.2±0.9 F组间=20.092，P＜0.001；F时间=85.739，P＜0.001；F交互=7.470，P＜0.001；与非糖尿病组比较，*P＜0.01，#P＜0.001
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表 3 糖尿病组与非糖尿病组患者术后不同时间点运动状态下VAS评分比较
($\bar x \pm s$，分) 组别 术前 术后4 h 术后1 d 术后2 d 术后3 d 术后4 d 术后5 d 糖尿病组(n=49) 5.2±1.3 1.0±0.7 5.7±2.2 7.0±1.1# 6.8±1.4# 6.2±1.3# 5.2±1.2# 非糖尿病组(n=68) 5.5±1.1 0.9±0.7 5.0±2.1 5.4±1.6 5.0±0.8 4.2±1.2 3.7±1.1 F组间=32.554，P=0.001；F时间=278.791，P＜0.001；F交互=8.908，P＜0.001；与非糖尿病组比较，#P＜0.001
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表 4 糖尿病组与非糖尿病组术后不同时间点口服羟考酮剂量比较
($\bar x \pm s$, mg) 组别 术后1 d 术后2 d 术后3 d 术后4 d 术后5 d 糖尿病组(n=49) 4.29±3.68 9.26±4.90* 8.37±4.83# 7.96±4.89# 6.63±4.23# 非糖尿病组(n=68) 4.12±3.86 6.39±3.94 5.81±3.07 4.93±4.01 4.63±3.80 F组间=14.120，P＜0.001；F时间=1.383，P＜0.001；F交互=2.932，P=0.021；与非糖尿病组比较，*P＜0.01，#P＜0.001
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表 5 糖尿病组与非糖尿病组术后不同时间段镇痛泵输注剂量的比较
($\bar x \pm s$, mL) 组别 术后4 h内 术后24 h内 术后48 h内 糖尿病组(n=49) 8.36±1.73 41.97±8.54* 50.83±10.18* 非糖尿病组(n=68) 8.35±2.23 38.99±6.17 47.10±5.69 F组间=5.462，P=0.021；F时间=2576.812，P＜0.001；F交互=5.409，P=0.030；与非糖尿病组比较，*P＜0.01
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表 6 糖尿病组与非糖尿病组患者PCIA使用期间不良反应比较
[n(%)] 组别 恶心呕吐 头晕 糖尿病组(n=49) 19(38.8) 6(12.2) 非糖尿病组(n=68) 30(44.1) 12(17.6) P值 0.580 0.140 PCIA:患者自控镇痛
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[1] 王关杰, 张磊.物理治疗在膝骨关节炎康复治疗中的应用[J].泸州医学院学报, 2017, 40:209-213. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lzyxyxb201702026 [2] 侯晓玲, 谢小伟, 涂晓晴, 等.加速康复下全膝关节置换术后急性疼痛多因素分析及对策[J].四川医学, 2018, 39:379-382. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=scyx201804004 [3] 赵希兵, 胡宝辉, 冯玉欣.2型糖尿病患者一级亲属糖尿病患病率及高危因素分析[J].解放军预防医学杂志, 2017, 35:728-729, 745. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=jfjyfyxzz201707007 [4] Eitner A, Pester J, Vogel F, et al. Pain sensation in human osteoarthritic knee joints is strongly enhanced by diabetes mellitus[J]. Pain, 2017, 158:1743-1753. doi: 10.1097/j.pain.0000000000000972 [5] Rajamäki TJ, Jämsen E, Puolakka PA, et al. Diabetes is associated with persistent pain after hip and knee replacement[J]. Acta Orthop, 2015, 86:586-593. doi: 10.3109/17453674.2015.1044389 [6] 中华医学会麻醉学分会.成人手术后疼痛处理专家共识[J].临床麻醉学杂志, 2017, 33:911-917. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmzxzz201709019 [7] 唐帅, 黄宇光.术后镇痛理念新跨越:从超前镇痛到预防性镇痛[J].协和医学杂志, 2014, 5:106-109. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_xhyx201401023&dbid=WF_QK [8] Bolognesi MP, Marchant Jr MH, Viens NA, et al. The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States[J]. J arthroplasty, 2008, 23:92-98. doi: 10.1016/j.arth.2008.05.012 [9] Wada O, Nagai K, Hiyama Y, et al. Diabetes is a Risk Factor for Restricted Range of Motion and Poor Clinical Outcome After Total Knee Arthroplasty[J]. J Arthroplasty, 2016, 31:1933-1937. doi: 10.1016/j.arth.2016.02.039 [10] 庄心良, 曾因明, 陈伯銮.现代麻醉学(上下)(第3版)[M].北京:人民卫生出版社, 2004:632-633. [11] Lewis GN, Rice DA, Mcnair PJ. Conditioned pain modulation in populations with chronic pain: a systematic review and meta-analysis[J]. J Pain, 2012, 13:936-944. doi: 10.1016/j.jpain.2012.07.005 [12] Edwards RR, Dolman AJ, Martel MO, et al. Variability in conditioned pain modulation predicts response to NSAID treatment in patients with knee osteoarthritis[J]. BMC Musculoskelet Disord, 2016, 17:284. doi: 10.1186/s12891-016-1124-6 [13] Mills K, HüBscher M, O'Leary H, et al. Current concepts in joint pain in knee osteoarthritis[J]. Schmerz, 2019, 33:22-29. doi: 10.1007/s00482-018-0275-9 [14] 咸振杰.膝骨性关节炎伴糖尿病患者与空腹血糖水平正常的患者TKA术后早期炎症反应因子的变化趋势及临床意义[D].广州: 广州医科大学, 2016. [15] 朱延波.2型糖尿病周围神经损害对膝关节骨关节炎严重程度的影响[J].实用妇科内分泌电子杂志, 2016, 3:133, 135. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=syfknfm-e201605083 [16] 向茂英, 王艳琼, 宁宁.全髋膝关节置换术后患者急性疼痛比较及影响因素分析[J].护士进修杂志, 2016, 31:111-115. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=hsjxzz201602006 [17] 朱鸣雷, 黄宇光, 刘晓红, 等.老年患者围手术期管理北京协和医院专家共识[J].协和医学杂志, 2018, 9:36-41. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_xhyx201801010&dbid=WF_QK -
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