摘要
目的探讨围手术期超前+多模式镇痛对治疗老年髋部骨折快速康复的影响。方法选择2016年12月至2018年12月因髋部骨折就诊于承德市中心医院的老年患者120例,分为试验组和对照组,每组60例。试验组应用入院后即刻给予超声引导下髂筋膜间隙阻滞术+口服塞来昔布+术后再次给予超声引导下髂筋膜间隙阻滞术+术后口服塞来昔布+自控静脉镇痛方案,对照组应用术前口服塞来昔布+术后自控静脉镇痛方案。观察记录两组患者T0、T1、T2、T3、T4、T5(分别为入院后即刻、镇痛实施后1 h、4 h、术前当日早晨、术后4 h、术后1 d)静息及运动视觉模拟评分(visual analogue scale,VAS),并检测相应时间点的PGE-2,IL-6,IL-10浓度,记录镇痛及麻醉后不良反应、止痛泵追加次数、地佐辛用药次数;记录患者术前等待时间、围手术期并发症。结果试验组在T1、T2、T3、T4、T5相同时间点的静息及运动VAS评分均低于对照组的VAS评分,差异均有统计学意义(P<0.05);试验组与对照组血清中PGE-2,IL-6及IL-10浓度比较,在TI至T5不同时间点的浓度均呈现上升、下降、再上升的趋势,试验组在相同时间点的相应浓度均低于对照组,差异均有统计学意义(P<0.05)。两组间术后镇痛出现的呕吐、恶心、头晕、嗜睡不良反应比较差异无统计学意义(P>0.05);试验组术后止痛泵追加的次数及地佐辛用药例数比对照组减少,差异有统计学意义(P<0.05)。试验组术前等待时间T(40.12±6.73)h与对照组(44.93±12.81)h比较,差异有统计学意义(P<0.05)。试验组肺炎、泌尿系感染、下肢深静脉血栓发生率明显降低,与对照组比较,差异有统计学意义(P<0.05)。结论应用超前+多模式镇痛方法,为老年髋部骨折患者在围手术期提供一种安全有效镇痛方式。
Objective To investigate the effect of preemptive and multimodal analgesia on the rapid recovery of perioperative elderly patients with hip fracture.Methods A total of 120 elderly patients with hip fracture,who visited Chengde Central Hospital from December 2016 to December 2018,were randomly divided into two groups:test group and control group.Two different analgesic schemes[ultrasound-guided fascia iliac compartment block(FICB)and oral celecoxib immediate after admission+postoperative FICB,oral celecoxib and self-controlled epidural analgesia in test group;oral celecoxib+postoperative self-controlled epidural analgesia in control group]were used in the patients.visual analogue scale(VAS)of rest and exercise was collected at the time of admission(T0),1 h after FICB(T1),4 h after FICB(T2),the morning of surgery day(T3),1 h after surgery(T4),and 1 d after surgery(T5).Serum levels of PGE-2,IL-6,IL-10 were also measured at the corresponding time points.The analgesic and post-anesthesia adverse reactions,the times of additional analgesia pump,and the times of Dezocine administration were recorded.The preoperative waiting time and perioperative complications were analyzed.Results The VAS scores of rest and exercise at the time points of T1,T2,T3,T4 and T5 in test group were lower than those in control group(P<0.05).The levels of PGE-2,IL-6 and IL-10 in test group and control group were increased,then decreased and re-increased from T0 to T5.The levels of PGE-2,IL-6 and IL-10 in test group were lower than those in control group(P<0.05).The occurrence of adverse reactions of nausea,vomiting,dizziness and somnolence in the two groups was similar.The times of additional analgesic pump and the times of Dezocine administration in test group were less than those in control group(P<0.05),and the waiting time before operation in test group was shorter compared with control group(P<0.05).The incidence of pneumonia,urinary tract infection and lower limb thrombosis in test group was lower than that in control group(P<0.05).Conclusion The use of preemptive and multimodal analgesia provides a safe and effective analgesic method for the elderly patients with hip fracture in perioperative period.
作者
朴海旺
王荣升
赵胜军
金宝城
PIAO Haiwang;WANG Rongsheng;ZHAO Shengjun;JIN Baocheng(Department of Orthopedics,the Central Hospital of Chengde,Chengde 067000,China)
出处
《大连医科大学学报》
CAS
2020年第4期313-317,338,共6页
Journal of Dalian Medical University
基金
承德市科学技术研究与发展计划项目(20151008)。
关键词
老年髋部骨折
超前镇痛
多模式镇痛
快速康复
elderly hip fracture
preemptive analgesia
multimodal analgesia
fast track surgery
