探讨多模式镇痛下全膝关节置换术后患者急性疼痛控制状况及其影响因素，为疼痛管理提供依据。

采用方便抽样方法将2017年6月至2018年6月在兰州大学第二医院骨1科确诊为膝骨关节炎拟行全膝关节置换术，年龄40～80岁，意识清楚的患者，排除伴有其他疾病引起疼痛和严重的心、肝、肾疾病者后共纳入200例患者为研究对象，于术前24 h用一般资料问卷调查；术后24 h、48 h、72 h分别用疼痛评估尺测量疼痛程度；术后72 h用休斯顿疼痛表调查术后急性疼痛控制状况。疼痛控制状况、疼痛程度、年龄、身体质量指数(BMI)、疼痛年限、镇痛药用药时间、膝关节功能评分及术前心理学资料用(±s)描述，两组间比较采用t检验；性别、文化程度、劳动强度、既往疼痛史、软骨损伤程度用百分比表示，两组间比较采用卡方检验。

研究对象均希望术后疼痛控制在轻度范围内；休斯顿疼痛调查表测得术后72 h时的平均疼痛为(3.2±0.8)分，患者急性期仍有中度疼痛；研究对象对控制疼痛教育的满意度较低。有术后急性疼痛的患者与无急性疼痛的患者比较年龄更大(t＝7.392，P<0.05)、BMI更大(t＝6.214，P<0.05)、镇痛药使用时间更长(t＝7.392，P<0.05)、术前活动时疼痛强度更大(t＝1.321，P<0.05)、软骨损伤程度更大(χ²＝0.519，P<0.05)、疼痛信念与感知(t＝2.121，P<0.05)和疼痛灾难化更明显(t＝1.103，P<0.05)，其差异均具有统计学意义。logistic回归显示：BMI、术前活动时疼痛强度、软骨损伤程度和疼痛灾难化能够显著影响术后急性疼痛的控制。

多模式镇痛下TKA术后急性疼痛控制状况有明显好转。患者的BMI、术前活动时疼痛强度、软骨损伤程度和疼痛灾难化能够显著影响术后急性疼痛的控制。

Objective To explore the status and influencing factors of acute pain control in patients after total knee arthroplasty under multimode analgesia, and to provide basis for pain management.

From June 2017 to June 2018, the patients who were diagnosed with knee osteoarthritis in the department of orthopedics of the Lanzhou University Second Hospital and who were to undergo total knee arthroplasty, age 40~80 years and with clear consciousness, were selected by handy sampling method. A total of 200 patients were included after excluding patients with pain caused by other diseases and severe heart, liver and kidney diseases. General information questionnaire was used 24 h before surgery; 24 h, 48 h and 72 h after surgery, pain scale was used to measure the degree of pain. The Houston pain scale was used to investigate the postoperative acute pain control 72 h after surgery. Pain control status, pain degree, age, body mass index(BMI), numbers of years of pain, analgesics, duration of analgesics, knee function score and preoperative psychological data were described by(±s), and t test was used for comparison between the two groups; gender, education level, labor intensity, previous pain history, cartilage injury degree were expressed as percentage, and chi-square test was used for comparison between the two groups.

All the patients hoped to control the postoperative pain within the mild range. The mean pain score 72h after the surgery was (3.2±0.8), and the patient still had moderate pain in the acute phase. Subjects were less satisfied with pain control education. The patients had acute pain were significantly older in age(t=7.392, P<0.05), had larger BMI(t=6.214, P<0.05), longer duration of analgesic use(t=7.392, P<0.05), higher intensity of preoperative pain(t=1.321, P<0.05), higher degree of cartilage injury(χ²=0.519, P<0.05), more remarkable pain belief and perception(t=2.121, P<0.05) and catastrophic pain (t=1.103, P<0.05). Logistic regression showed that BMI, pain intensity during preoperative activities, degree of cartilage injury and pain disaster could significantly affect the control of postoperative acute pain.

The acute pain following TKA can be relieved obviously under multimode analgesia. BMI, pain intensity during preoperative activities, degree of cartilage damage and pain catastrophic can significantly affect the control of postoperative acute pain.