2种不同镇痛方式应用于四肢骨折术后的对比研究

Comparative study of patient controlled analgesia and continuous local anesthetic infusions after surgery for limbs fracture

目的创伤骨折术后围手术期疼痛处理,可以采用多通道阵痛模式。近年来采用的局部镇痛装置是作用于局部的新型镇痛通道之一,能有效缓解疼痛的同时减少传统静脉镇痛泵的不良反应。采用对比研究的方式,比较局部镇痛装置和静脉镇痛泵的临床应用疗效。方法 2010年9月—2012年3月收治的四肢闭合性骨折行切开复位内固定术患者60例,均于损伤后1周内进行手术。其中男性45例,女性15例;年龄22~63岁,平均39.8岁。术前通过X线片、CT明确骨折部位,排除开放性骨折及手、足部骨折患者。予以手术切开复位内固定,术后围手术期镇痛模式选择根据患者自愿的原则分别采用静脉镇痛泵及局部镇痛装置两种方法镇痛处理。记录术后不同时间点的疼痛视觉模拟评分VAS、术后口服曲马多量及不良事件发生情况。获得数据采用SPSS 13.0软件进行统计分析。结果所有患者完成手术后均采用镇痛处理,总体效果满意。静脉镇痛泵组和局部镇痛装置组患者在术后不同时间点记录的VAS值分别为术后第1天2.79±0.59和2.74±0.50、术后第3天1.67±0.58和1.49±0.37（P〉0.05）,口服曲马多总量分别为（125.45±31.28）mg和（110.57±42.63）mg（P〉0.05）,但是在不良事件发生率方面比较2组分别为30.00%和6.67%（P〈0.05）。结论局部镇痛装置是一种新的术后镇痛给药途径,可以作用于术后疼痛的感受器区域,具有良好镇痛效果的同时避免静脉给药途径的全身不良反应,是临床围手术期镇痛可选择的新途径之一。

Objective To evaluate the clinical curative effects of patient controlled analgesia and continuous local anes- thetic infusions in patients receiving limbs fracture surgery. Methods From September 2010 to March 2012,60 patients （45 males and 15 females,aged 22 -63 years with an average of 39.8 years） suffering limbs closed fractures underwent open reduction and internal fixation（ORIF）. All operations were performed within one week after the injury. X ray and CT were performed to confirm the fracture sites, exclude open fractures and fractures in hands and feet. The patient controlled analgesia or continuous local anesthetic infusions after the operations were chosen according to the voluntary principle. The visual analogue scale（VAS） on different time points ,postoperative oral dose of Tramadol,and incidence of adverse events was recorded. SPSS 13.0 was employed to do the statistical analysis. Results All patients adopted analgesia after the op- eration and the overall effect was satisfied. VAS for patient controlled analgesia and continuous local anesthetic infusions were 2.79 ± 0. 59 and 2.74 ± 0.50 on dl, 1.67 ± 0.58 and 1.49 ± 0.37 on d3 after the surgery（ P 〉 0.05 ） ; postoperative oral dose of Tramadol were （125.45 ± 31.28） mg and （110.57 ± 42.63 ）mg（P 〉 0.05 ） ;the incidence of adverse events were 30.00% and 6.67 %, the difference was significant （ P 〈 0.05 ）. Conclusion The continuous local anesthetic infu- sions as a new way of administration can improved pain management outcomes, decrease the incidence of adverse events. It is one of the new approaches for clinical perioperative analgesia.