The Efficacies Of Different Cryotherapy Methods On Patients With Total Knee Arthroplasty

Objective:To observe the efficacies of cryotherapy methods on knee joint pain,swelling and exudation in patients with TKA 24 hours after operation,so as to provide basis for cold therapy nursing in patients with TKA.Methods:From January 2018 to October 2018,166 patients with TKA in the department of arthrology were selected as the subjects of study.Random number table method was used to divide them into five groups.Patients received different cold therapy after TKA.Intermittent cryotherapy for 30minutes group was 30 minutes with an interval of 1 hour.Four cycles of cryotherapy were performed after operation.Intermittent cryotherapy for 1hour group was 1 hour,and the interval was 1 hour.Four cycles of cryotherapy were performed after operation.Intermittent cryotherapy for 2 hours group was 2 hours,and the interval was 1 hour.Four cycles of cryotherapy were performed after operation.Patients in the 4 hours group received continuous cold therapy for 4 hours after operation.The patients in the control group were not treated with cold therapy.Demographic data were collected before operation,such as gender,age,BMI,NRS score,HSS,knee swelling,RBC,WBC,Hb,NEUT%,CRP and ESR.The data were evaluated 24 hours after the operation,including NRS score,drainage,PGE2,knee swelling,RBC,WBC,Hb,NEUT%,CRP and ESR.SPSS 21.0 statistical software was used for statistical analysis,P≤0.05 showed that there were significant difference.Results:There was no significant difference in the demographic data of every group.The NRS of 24 hours after TKA in each group were significantly different(χ~2=77.36,P<0.01).The NRS scores of 5 groups with intermittent cold therapy for 2 hours were the lowest(1.00).The NRS scores of 5.00(1.00)and 4 hours with intermittent cold therapy were lower than those of 5.50(1.00)and 6.00(1.00)in 30 minutes with intermittent cold therapy and 6.00(1.00)in the control group(P<0.05).The difference of swelling in each group was statistically significant(χ~2=18.73,P<0.01).The knee circumference of the two-hour intermittent cold therapy group was 45.50(11.50)cm and that of the four-hour continuous cold therapy group was 45.00(8.00)cm,which were less than the 50.00(3.75)cm of the 30-minute intermittent cold therapy group,51.00(8.50)cm of the one-hour intermittent cold therapy group and 49.00(9.00)cm of the control group(P<0.05).The difference of drainage among groups was statistically significant(F=5.06,P<0.01).The drainage of the two-hour intermittent cold therapy group(108.24±37.45 mL)and the four-hour continuous cold therapy group(114.36±29.29 mL)were less than that of the 30-minute intermittent cold therapy group(134.06±38.43 mL),the one-hour intermittent cold therapy group(136.06±39.52 mL)and the control group(138.29±32.67 mL).The difference of PGE2 in drainage fluid 24 hours after TKA was statistically significant(χ~2=22.77,P<0.01).The PGE2 in drainage fluid of the one-hour intermittent cold therapy group,the two-hour intermittent cold therapy group and the four-hour continuous cold therapy group were less than that of the 30-minute intermittent cold therapy group and the control group.There were no significant differences in RBC,WBC,Hb,NEUT%,CRP and ESR among groups after TKA(P>0.05).Conclusions:Intermittent cold therapy for 2 hours or continuous cold therapy for 4 hours alleviated the pain and swelling of knees 24 hours after TKA.Intermittent cryotherapy for 2 hours or continuous cryotherapy for 4hours reduced the drainage and the amount of PGE2 in drainage fluid 24 hours after operation.There were no differences in RBC,WBC,Hb,NEUT%,CRP and ESR 24 hours after operation among intermittent cold therapy for 30minutes,intermittent cold therapy for 1 hour,intermittent cold therapy for 2hours,continuous cold therapy for 4 hours and no cold therapy.