下肢游离皮瓣移植术患者超前镇痛的效果观察及护理

Effect of Multi-mode Preemptive Analgesia in Patients Undergoing Free Lower Limb Skin Flap Transplantation and Its Nursing

目的观察下肢游离皮瓣移植术患者术前应用塞来昔布,联合术后使用自控静脉镇痛的镇痛效果,总结护理经验。方法选择2011年7月—2013年6月在本院创伤骨科择期行下肢游离皮瓣移植术的患者120例,按手术时间随机分为单次给药组、双次给药组和常规给药组,每组40例。单次给药组在常规术后镇痛的基础上于术前2 h口服塞来昔布400 mg;双次给药组在单次给药组的基础上,术前24h增加口服塞来昔布400mg1次;常规给药组不进行超前给药,只使用常规术后镇痛方法。结果 3组患者术后各时点芬太尼使用总量以及镇痛药物不良反应发生率差异均无统计学意义(P>0.05)。单次给药组和双次给药组术后8 h开始疼痛评分显著低于对照组(P<0.05)。单次给药组和双次给药组患者满意度显著高于对照组(P<0.05)。结论下肢游离皮瓣移植术患者术前应用塞来昔布,联合术后使用自控静脉镇痛的镇痛效果明显优于常规镇痛,能显著提高患者的舒适度及满意度。由于单次给药组和双次给药组在疼痛评分、药物不良反应发生率方面无统计学差异,而单次给药组在给药次数及减少患者医疗费用方面有其优势,笔者建议临床使用单次给药的方式。

Objective To observe the effect of multi-mode preemptive analgesia on patients undergoing free lower limb skin flap transplantation and to summarize its nursing experience. Methods Totally 120 patients treated with free lower limb skin flap transplantation from July 2011 and June 2011 were randomized into the multi-mode preemptive analgesia groups （including single-dose group and double-dose group） and control group according to the time of operation, 40 patients in each group. These groups were treated with preemptive analgesia and routine analgesia respectively. Results The three groups showed no significant difference in total dosage of Fentanyl and adverse reactions caused by analgesics （ P＆gt;0.05）. The postoperative VAS pain rating scale of the multi-mode preemptive analgesia groups were significantly lower than that of control group （ P〈0.05）. The satisfaction of the multi-mode preemptive analgesia groups were significantly higher than that of control group （ P〈0.05）. Conclusion The multi-mode preemptive analgesia with Celecoxib combined with patient-controlled analgesia （PCA） in patients treated with free lower limb skin flap transplantation is significantly superior to the routine analgesia effect. Moreover, the multi-mode preemptive analgesia can enhance patients’ satisfaction.