人工全膝关节置换术围手术期镇痛管理.ppt

方法：硬膜外（PCEA）时间：单次、持续药物：吗啡、曲马多、利多卡因、肾上腺素PCEA优点：镇痛质量好，可控性强，全身影响相对小缺点：呼吸抑制、恶心、呕吐、嗜睡、尿潴留、便秘、低血压、头痛和感染有出血倾向的病人禁用腰椎中枢神经系统镇痛策略方法：口服、肌注、静脉PCA时间：一次、持续药物：NSAIDS、强阿片药物、右美沙芬、可乐定01静脉PCA02优点：操作简单，起效快03缺点：镇痛不足、胃肠道、嗜睡、尿潴留、低血压产生耐受性和依赖性04全身性镇痛策略外周神经元背角脊根神经节疼痛选择性COX-2抑制剂抑制COX-2过量表达降低术后痛觉超敏调制外周伤害感受器选择性COX-2抑制剂抑制外周炎症选择性COX-2抑制剂在多模式镇痛中的作用250patientswhohadundergonesurgicalprocedures(in-andoutpatient)inthepastyearcompletedaquestionnaireabouttheirexperienceswithpainbeforeandaftersurgery.Themostcommonconcernthatpatientsexpressedpriortosurgerywasexperiencingpain(59%),whichwascitedmoreoftenthanconcernsaboutwhetherthesurgerywouldimprovetheircondition(51%)orwhethertheywouldfullyrecover(46%).58%ofthesamplereportedpainpriortosurgery.Despitereceivingtreatmentforpain,82%reportedpainintheimmediatepostsurgicalperiod(endofsurgeryupto2weeksafterdischarge)and75%reportedpainafterdischarge.Morethantwothirdsofpatientsreportedpainofmoderatetosevereintensity,andextremepainwasreportedby18%overalland8%afterdischarge.ApfelbaumJL,ChenC,MehtaSS,GanTJ.Postoperativepainexperience:resultsfromanationalsurveysuggestpostoperativepaincontinuestobeundermanaged.AnesthAnalg.2003;97:534-540.人工膝关节置换围手术期镇痛管理阳江市中医医院骨关节科孙小东2016.12人工膝关节置换围手术期镇痛管理概述TKA术后疼痛机制镇痛策略目标人工全膝关节置换术（totalkneearthroplasty,TKA）——解除膝关节疼痛——重建膝关节功能TKA日趋成熟TKA数量10%-20%递增概述概述Bonica,PostoperativePain.Philadelphia,1990,P461McHughGA,physicalfunctioningandqualityoflifeofindividualsawaitingtotaljointreplacement.JEvalClinPract,2008,14(1):19-26TKA术后60%会经历严重疼痛30%为中等度疼痛95%产生焦虑不安疼痛：TKA围手术期最主要问题0102概述1疼痛:2第五大生命体征脉搏血压体温呼吸3TKA术后疼痛概述BuvanendranA,etal.JAMA.2003,290(18):2411-8吴海山.全膝关节置换术围手术期疼痛控制现状及思考.实用医学杂志2007,23(18):2814-52018影响术后的早期功能锻炼012019延迟关节功能恢复022020深静脉血栓032021肺栓塞042022感染……05TKA术后良好镇