人工髋关节置换术后多模式镇痛的临床观察

The effect of multimodal postoperative analgesia in patients undergoing artificial hip replacement surgery

目的:比较氟比洛芬酯复合舒芬太尼、地佐辛复合舒芬太尼以及氟比洛芬酯复合地佐辛用于人工髋关节置换术患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)的效果。方法:选取择期行人工髋置换术的患者60例,随机分成氟比洛芬酯复合舒芬太尼(FS组)、地佐辛复合舒芬太尼(DS组)以及氟比洛芬酯复合地佐辛(FD组)3组,每组20例。所有患者均采用腰硬膜联合麻醉,术后采用PCIA。FS组镇痛首剂给予氟比洛芬酯50 mg+托烷司琼2 mg,镇痛泵配方为氟比洛芬酯200 mg+舒芬太尼2μg/kg+托烷司琼4 mg;DS组镇痛首剂给予地佐辛5 mg+托烷司琼2 mg,镇痛泵配方为地佐辛20 mg+舒芬太尼2μg/kg+托烷司琼4 mg;FD组镇痛首剂给予氟比洛芬酯50 mg+托烷司琼2 mg,镇痛泵配方为氟比洛芬酯200 mg+地佐辛20 mg+托烷司琼4 mg。术毕前30 min给予镇痛首剂和托烷司琼2 mg,接静脉镇痛泵。观察患者术后12、24、48 h被动活动时和静息时视觉模拟评分(visual analogue scale,VAS疼痛评分)、Ramsay镇静评分及恶心、呕吐、头晕、呼吸抑制、深静脉血栓的发生率。结果:静息时:术后12、24 h VAS疼痛评分DS组明显高于FS组和FD组(P<0.05),FD组与FS组间差异无统计学意义(P>0.05);被动活动时:术后12、24 h VAS疼痛评分在DS组、FD组、FS组依次降低,两两比较差异有统计学意义(P<0.05);Ramsay镇静评分:术后12、24 h DS组较FS组明显降低(P<0.05);泵按压次数:术后12、24 h DS组较FS组、FD组明显增多(P<0.05);头晕的发生率FS组较DS组、FD组显著降低。结论:氟比洛芬酯联合舒芬太尼或地佐辛均可有效地缓解人工髋关节置换术后静息痛,但对运动痛的制止效果前者更佳,且不良反应较少。地佐辛复合舒芬太尼的协同镇痛效果不如氟比洛芬酯联合舒芬太尼或地佐辛,且头晕发生率偏高。

Objective： To compare the efficacy of flurbiprofen axetil combined with sufentanil, dezocine combined with sufentanil and flurbiprofen axetil combined with dezocine for postoperative patient-controlled intravenous analgesia（PCIA） in patients undergoing artificial hip replacement surgery. Methods： Selecting 60 cases of artificial hip replacement surgery was randomly allocated to flurbiprofen axetil combined with sufentanil group（group FS）, dezocine combined with sufentanil （group DS） and flurbiprofen axetil combined with dezocine（group FD） with 20 cases each. All the patients were administered with combined subarachnoid and epidural anesthesia during the surgery and treated with PCIA according to different formula：group FS received flurbiprofen axetil 50 mg and tropisetron 2 mg for the first dose of analgesia and followed by flurbiprofen axetil 200 mg and sufentanil 2 μg/kg plus tropisetron 4 mg PCIA, group DS received dezocine 5 mg and tropisetron 2 mg for the first dose of analgesia and followed by dezocine 20 mg and sufentanil 2 μg/kg plus tropisetron 4 mg PCIA, group FD received dezocine 5 mg and tropisetron 2 mg for the first dose of analgesia and followed by dezocine 20 mg and flurbiprofen axetil 200 mg plus tropisetron 4 mg PCIA. The first dose of analgesia was administered at 30 min before the end of surgery and tropisetron 2 mg was also intravenously injected to all patients. Visual analogue scale（VAS） during both silence and passive movement,Ramsay score at 12, 24, 48 h after the operation and adverse effects on 48 h after the operation were recorded respectively. Results： VAS pain score is significantly higher in group DS than that in group FS or FD at 12, 24 h after the operation during silence, while VAS pain score of group DS, group FD, group FS fell in turn with significantly differences among the groups at 12 h after the operation, but it＇s higher in group DS than that in group FS or group FD at 24 h after the operation during passive movement（P〈0.05）. And Ramsay sedation score was lower in group DS than those in group FS or FD at 12, 24 h after the operation（P〈0.05）. Accordingly Total number of attempts were significantly higher in group DS than those in group FS or FD at 12, 24 h after the operation. The incidence of dizziness rate was remarkably higher in DS group than that in group FS or group FD. Conclusion： Flurbiprofen axetil combined with sufentanil PCIA has similar analgesic efficacy to flurbiprofen axetil combined with dezocine PCIA during silence, but better analgesic efficacy during passive movement and less adverse effects in patients undergoing artificial hip replacement surgery. And dezocine combined with sufentanil has less analgesic effect and more adverse effects when compared with other two combined formula.