术后不同镇痛方法对胸-腰椎内固定患者镇痛效果的影响

Effects of Different Antalgic Methods on Postoperative Pain in Internal Fixation Patients with Thoracolumbar Vertebrae Fractures

目的观察胸-腰椎内固定术后不同镇痛方法对其镇痛效果的影响。方法择期经后路内固定胸-腰椎骨折患者90例,随机分为3组:静脉镇痛组(PCIA组)、椎板减压硬膜外镇痛组(PCEA1组)和椎板不减压硬膜外镇痛组(PCEA2组),每组30例。分别于术后4,8,12,24,36,48h记录视觉模拟(VAS)评分、吗啡用量、镇静程度、不良反应和术后镇痛总体满意度。结果术后36h内PCEA2组VAS评分低于PCIA组和PCEA1组(P<0.05),术后24h以内PCIA组镇静评分高于PCEA1组和PCEA2组患者(P<0.05),术后48h之内PCIA组吗啡用量高于PCEA1组和PCEA2组(P<0.01);PCIA组恶心、呕吐、瘙痒发生率均明显高于PCEA1组和PCEA2组(P<0.05);结论椎板不减压患者PCEA镇痛效果最佳,不良反应少,患者满意度高。

Objective To investigate the effects of different antalgic methods on postoperative pain after internal fixation of thoracolumbar vertebrae fractures. Methods Ninety patients undergoing thoracolumbar spinal surgery were randomly divided into three groups of thirty patients each according to the methods of postoperative pain management ： group PCIA received patient-controlled intravenous analgesia with morphine 0.5 mg · mL^-1 （n = 30）; group PCEA1 received patientcontrolled epidural analgesia with 0.125 % bupivacaine ＋ morphine 0.04 mg · mL^-1 （n = 30 ） , epidural space was opened during surgery; group PCEA2 received patient-controlled epidural analgesia with 0. 125% bupivacaine ＋ morphine 0.04 mg · mL^-1 （ n = 30） ,epidural space was not opened during surgery. PCA was maintained for 48 h in all three groups. VAS scores were used to assess analgesia at rest and movement. Cumulative morphine requirement and side effects（ nausea, Vomiting and pruritus）were recorded after 4,8,12,24,36,48h of postoperative analgesia. Results During the 36 hours after operation, the VAS scores in group PCEA2 at rest and motion were significantly lower than those in group PCIA and PCEA1 （ P 〈 0.05 ）. During the 24 hours after operation, the degree of sedation was higher in group PCIA than that in other two groups （P 〈 0.05 ）, The total morphine requirement was significantly larger in group PCIA than that in other two groups （P 〈 0.01 ）. The prevalences of postopertive nausea, vomiting and pruritus were markedly higher in group PCIA than those in other two groups（P 〈 0.05 ）. Conclusion PCEA2 is more effective than PCIA with lower opioid consumption, fewer side effects, and a higher satisfaction for patients with thoracolumbar vertebrae fractures .