老年患者全髋置换术后多模式镇痛的探讨

Postoperative Multimodality Analgesis in Elderly Patients Undergoing Total Hip Replacement

目的:探讨多模式镇痛用于老年全髋关节置换术后的效果及不良反应。方法:选择择期在连续硬膜外麻醉下行全髋关节置换术的老年患者90例,随机分为三组(n=30)。A组单纯使用静脉自控镇痛(PCIA);B组经硬膜外单次注射吗啡后,再实行PCIA;C组在B组方法的基础上,使用帕瑞昔布钠静脉分次注射。三组患者的镇痛泵配方均为0.2 g/L地佐辛,于手术结束后开启,以LCP模式进行镇痛。观察各组患者术后不同时间点的NRS评分、Ramsay镇静评分、不良反应以及有效PCA按压次数。结果:A组患者术后4 h与8 h的NRS评分和有效PCA按压次数高于B、C组(P<0.05),各时间点的Ramsay镇静评分A组均高于B组和C组(P<0.05);而B、C组NRS、Ramsay评分及有效PCA按压次数差异均无统计学意义。C组不良反应发生率明显低于A、B组。结论:硬膜外联合静脉多模式镇痛,用于老年全髋关节置换术后,镇痛效果好且不良反应少,是一种值得推荐的术后镇痛方式。

Objective To investigate the effects and adverse reaction of multimodality analgesis in elderly patients undergoing total hip replacement. Methods Ninety elderly patients underwent total hip replacement with continuous epidural anesthesia were enrolled and randomly divided into three groups(n = 30) . Group A were treated with patient-controlled intravenous analgesia(PCIA) ,group B were treated with epidural single injection of morphine firstly,then given PCIA,group C were given multiple injection of parecoxib via vein based on the methods of group B. The prescription of analgesic pump was 0. 2 g / L dizocine in all three groups,and the pump was started with LCP model postoperation. The numerical rating scale(NRS) ,Ramsay sedation score,adverse reaction and pressed times of PCIA at different time points were recorded. Results The NRS and pressed times of PCIA of group A were significantly higher than those of group B and group C at 4,8 hours(all P < 0. 05) . Ramsay sedation scores of group A were significantly higher than those of group B and group C at each time points(P < 0. 05) . The NRS,Ramsay sedation scores and pressed times of PCIA of group B and group C had no significant differences. The incidence of adverse reactions of group C was significantly lower than those in group A and group B(P < 0. 05) . Conclusion Epidural analgesia combined with intravenous multimodality analgesia can effectively be used in elderly patients undergoing total hip replacement surgery with its excellent analgesic effect and fewer adverse reactions.