复合镇痛方剂用于脊柱后路手术术后镇痛的临床疗效观察

Observation of clinical effects of compound analgetic used in postoperative analgesia of posterior spinal surgery

[目的]观察复合镇痛方剂用于脊柱后路胸腰椎内固定手术病人术后镇痛的临床疗效。[方法]选择行后路脊柱胸腰椎内固定手术患者60例,双盲法随机分为A、B两组:A组为观察组,在病人术毕缝合皮肤前给予复合镇痛方剂(吗啡+肾上腺素+罗哌卡因+生理盐水)椎旁肌肌注,B组为对照组,不予肌注。记录术后4、8、12、24、36、48 h病人刀口疼痛VAS评分、镇静评分、不良反应(皮肤瘙痒、头晕、恶心、呕吐、呼吸抑制)发生情况及术后补救镇痛情况,调查患者满意率。[结果]观察组术后4、8、12、24、36、48 h刀口疼痛评分显著降低,镇静评分升高,且手术12 h后差异更明显,与对照组相比两组间差异有显著统计学意义(P<0.01),术后患者整体镇痛满意度明显提高(P<0.05),而有关不良反应发生率的差异无统计学意义(P>0.05),观察组与对照组相比能明显降低术后疼痛评分,减少术后补救镇痛次数。[结论]该复合镇痛方剂用于脊柱后路胸腰椎手术术后镇痛可取得良好的镇痛、镇静效果,不良反应少,安全性高,值得临床推广。

[ Objective] To evaluate the clinical effects of the postoperative analgesia compounded by spinal surgery applied in postoperative analgesia of posterior spinal surgery. [ Method] A total number of 60 patients who were going to have posterior spinal operatons of thoracic and lumbar vertebra internal fixation were chosen for this double - blind test and were randomized into two groups（ Group A and Group B） with no statistical difference（P 〉0.05）. Group A acted as obeservation group and the 30 patients in group A received multi - point injection into paravertebral muscle with compound analgetic （ morphine, ropiva- caine, epinephrine and physiological saline） before skin closure. Meanwhile another 30 cases served as control group and ac- quired no injection. Visual analogue scores（VAS） of the incision and Ramssay sedative scores and the occurance rate of side effects such as nausea,vomiting, dizziness, pruritis and respiratory depression were recorded at 4,8,12,24,36,48 hours after surgery respectively. At the same time total sastisfaction rate of postoperative analgesia and salvage analgesia after operation were investigated as well. [ Result] The mean VAS pain scores of both group declined but the observation group had significantly lower scores and higher Ramssay sedative scores compared with the control group at each testing hour point（ P 〈 0. 01 ）. There were also significantly higher total sastisfactory rate of postoperative analgesia and less morphine consumption for salvage analgesia after surgery in group A compared with group B （ P 〈 0.05 ）. Meanwhile the difference in occurance rate of side effects had no statistical significance （ P 〉 0. 05 ）. [ Conclusion ] The compound postoperative analgetic applied in postoperative analgesia of posterior spinal surgery provides excellent clinically curative effects and sedative effects. With high security and efficacy and little side effect proved, the compound analgetic is a promising analgesia method which is worth popularization.