| 摘要: |
| 目的:全膝关节置换术是治疗膝关节晚期退变最有效的方法之一,全膝关节置换手术不仅解决了患者的痛苦，还解决了社会问题，但是术后疼痛仍然是影响患者恢复的严重问题之一。本研究旨在探讨度洛西汀联合青鹏软膏治疗全膝关节置换术后患者疼痛的效果以及对于血清炎性因子的影响。方法:对2020年5月—2020年11月接受全膝关节置换手术的患者进行术前CSI评分，选取得分≥40的患者60名，随机平均分为治疗组(度洛西汀联合青鹏软膏)和对照组(塞来昔布)，每组各30名患者。对照组给予塞来昔布200mg，2次/d。治疗组给予度洛西汀20mg，2次/d，同时给予青鹏软膏，5 g，早晚各1次。两组从术后第1天开始实施，持续6周。观察两组术后第3天，第1、2、4、6周步行VAS疼痛评分；术后第1、2、4、6周WOMAC功能评分；术后第3天，第1、2、4、6周血清白介素-1(IL- 1)、白介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平。结果:两组术后第3天VAS评分比较无差异，术后第1、2、4、6周治疗组评分优于对照组，差异具有统计学意义(P＜0.05)。两组术后第1、2、4、6周的WOMAC功能评分治疗组优于对照组，差异具有统计学意义(P＜0.05)。两组术后第3天的IL-1，IL-6，TNF-α水平比较无明显差异(P＞0.05)，在术后第1、2、4、6周治疗组和对照组均下降，差异具有统计学意义(P＜0.05)。结论:度洛西汀联合青鹏软膏治疗对全膝关节置换术后疼痛具有良好的效果，促进患者快速康复，同时对于膝关节置换术后疼痛的患者可以进行中枢敏化量表评估，可以更有针对性的使用镇痛药物。因此，我们可以将度洛西汀联合青鹏软膏用于治疗膝关节置换术后早期疼痛。 |
| 关键词: 度洛西汀 青鹏软膏 全膝关节置换术 疼痛 白细胞介素1 白细胞介素 6 肿瘤坏死因子α |
| DOI：10.3969/j.issn.1007-6948.2021.05.019 |
| 投稿时间：2021-01-02 |
| 基金项目: |
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| Analysis of Effect of Duloxetine Combined with Qingpeng Paste in the Treatment of Early Pain after Total Knee Arthroplasty |
| WANG Tao,HE Sen,BIAN Hua |
| Department of Joint, Tianjin Beichen Hospital, Tianjin (300400), China |
| Abstract: |
| Objective Total knee arthroplasty is one of the most effective methods to treat advanced degeneration of the knee joint. Total knee arthroplasty not only solves the pain of patients but also solves social problems, however, postoperative pain continues to be one of the serious problems that affect patients’recovery. The aim of this study is to investigate the effect of duloxetine combined with Qingpeng paste on the treatment of pain in patients after total knee arthroplasty and the effect on serum inflammatory factor. Methods Preoperative CSI scores were performed in patients who underwent total knee replacement surgery from May 2020 to November 2020. 60 patients with scores (≥40) were selected and randomly divided equally into treatment group (duloxetine combined with Qingpeng paste) and control group (celecoxib), with 30 patients in each group. The control group was given celecoxib 200mg, 2 times/day. The treatment group was given duloxetine 20mg, 2 times/day, with Qingpeng paste, 5g, once in the morning and once in the evening. Both groups were run from the first postoperative day and lasted for 6 weeks. The walking VAS pain scores at postoperative day 3, weeks 1, 2, 4 and 6; WOMAC functional scores at postoperative weeks 1, 2, 4 and 6; interleukin-1 (IL- 1), interleukin-6 (IL6) and tumor necrosis factor (TNF-α) levels at postoperative day 3, weeks 1, 2, 4 and 6 were observed in both groups. Results There was no difference in VAS scores between the two groups on postoperative day 3, and the scores in the treatment group were better than those in the control group at postoperative weeks 1, 2, 4 and 6, with statistically significant differences(P<0.05). WOMAC functional scores in the 1st, 2nd, 4th and 6th postoperative weeks in the treatment group were better than those in the control group, which the difference was statistically signi?cant (P<0.05). There was no signi?cant difference in the comparison of IL-1, IL-6 and TNF-α levels between the two groups on postoperative day 3 (P>0.05), which decreased in both the treatment and the control groups at postoperative weeks 1, 2, 4 and 6, with statistically signi?cant differences (P<0.05). Conclusion Duloxetine combined with Qingpeng paste has good effect on postoperative pain after total knee arthroplasty, which can promote patient rapid recovery. At the same time, patients with postoperative pain after knee arthroplasty can be evaluated by central sensitization scale, which can use analgesic drugs in a more targeted way. Therefore, we can use duloxitine combined with Qingpeng paste for the treatment of early postoperative pain after knee arthroplasty. |
| Key words: Duloxetine Qingpengpaste total knee replacement pain interleukin-1(IL- 1) interleukin-6 (IL-6) tumor necrosis factor (TNF-α) |
