非止血带联合控制性降压技术对老年人全膝关节置换术后疼痛及远期预后的影响：一项随机对照研究
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Efects of the nontourniquet combined with controlled hypotension technique on pain and long‑term prognosis in elderly patients after total knee arthroplasty: a randomized controlled study
背景与目的
本研究的目的是证明非止血带技术对全膝关节置换术（TKA）后患者急性和慢性疼痛的缓解作用。
方 法
122名老年TKA患者随机分为两组：T组（n=58）和H组（n=64）。T组采用电子充气止血带行TKA。H组接受控制性降压但是在手术过程中不适用止血带。术后第1天、第2天、第3天、第7天用NRS评分法评定疼痛程度，术后3个月，1年随访评估慢性疼痛的发生率。同时以膝关节活动度（AROM）评价膝关节功能恢复情况。术后7天用蒙特利尔认知评定量表（MoCA）评定认知功能。
结 果
术后7天NRS评分及AROM无显著性差异。H组慢性疼痛发生率（25.0%）低于T组（41.4%），随访1年，H组AROM明显增高。第1天和第2天，H组MoCA评分低于T组。
结 论
非止血带联合控制性降压技术可以减轻慢性疼痛，促进TKA患者的长期康复。
原始文献摘要
Jun Dong， Su Min， Kai‑Hua He，et，al.Efects of the nontourniquet combined with controlled hypotension technique on pain and long‑term prognosis in elderly patients after total knee arthroplasty: a randomized controlled study[J]J Anesth 2019 Aug 19; DOI：10.1007/s00540-019-02671-z
Purpose The aim of this study was to confrm the alleviating efects of the nontourniquet technique on the postoperative acute and chronic pain of patients after total knee arthroplasty (TKA).
Methods 122 elderly patients undergoing TKA were randomly divided into two groups: group T (n=58) and group H (n=64). An electronic infatable tourniquet was used during TKA in group T. The patients in group H received controlled hypotension but without tourniquet use during the operation. The numeric rating scale (NRS) score was used to evaluate pain level on day 1, day 2, day 3 and day 7 after the operation, and the incidence of chronic pain was judged at 3-month and 1-year follow-ups, and functional recovery of the knee joint was estimated by the active range of knee joint motion (AROM) at the same time points. Cognitive function was assessed by the montreal cognitive assessment scale (MoCA) for 7 days after operation.
Results There were no signifcant diferences in the NRS scores and AROM for 7 days after surgery. The incidence rate of chronic pain in group H (25.0%) was lower than that in group T (41.4%) and the AROM in group H was greater at one year follow-up. The MoCA score in group H was lower than that in group T on day 1 and day 2.
Conclusion The nontourniquet combined with controlled hypotension technique can alleviate chronic pain and promote the long-term rehabilitation of patients after TKA.
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贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：何幼芹 审校：王贵龙