硬膜外与静脉联合在老年全髋关节置换术后镇痛应用效果

Epidural and Intravenous Combined in Elderly Patients After Total Hip Arthroplasty Analgesia Effect

目的探讨硬膜外与静脉联合在老年全髋关节置换术后镇痛中的应用效果。方法以该院2012年8月—2014年3月择期行全髋关节置换术的60例老年患者为研究对象,随机将其分为两组,各30例,对照组患者给予硬膜外镇痛处理,观察组患者则行硬膜外与静脉联合自控镇痛,对两组不同时段(术毕、术后6 h、24 h)血浆DA(多巴胺)、E(肾上腺素)、各时间点(镇痛泵开启后4 h、8 h、12 h)NRS评分及RSS评分、不良反应发生率进行比较。结果观察组术后6 h、24 h血浆DA、术后24 h血浆E均明显低于对照组(P<0.05)。两组镇痛泵开启后4 h、8 h时NRS评分、开启后4 h、8 h及12 h时RSS评分差异有统计学意义(P<0.05)。另外,观察组不良反应发生率13.33%,较对照组的36.67%比较差异有统计学意义(P<0.05)。结论硬膜外联合静脉自控镇痛效果良好,老年患者应激反应少,不良反应轻,值得临床推广。

Objective To explore the effect of epidural and intravenous combined in elderly hip replacement of postoperative analgesia. Methods 60 cases of elderly patients undergoing total hip arthroplasty in our hospital from August 2012 to March 2014 as the study object, were randomly divided into two groups, each of 30 cases, control group patients were given epidural analgesia treatment, the observation group underwent epidural and intravenous combined with patient-controlled analgesia, comparison of different time （after operation, postoperative 6h, 24h） plasma DA （dopamine） , E （epinephrine） at each time point （4 h, 8 h, 12 h after analgesia pump opening） NRS score and RSS score, adverse reaction rate of two groups. Results In observation group, after 6 h, 24 h and plasma DA, 24 h after the operation, the plasma levels of E were significantly lower than control group （P〈0.05）. differ-ence of analgesia pump after open 4h, 8h NRS score and after the opening 4h, 8h and 12h RSS score of two groups was significant （P 〈 0.05）. In addition, the adverse reaction in observation group was 13.33%, there was significant difference compared with 36.67%in control group （P 〈 0.05）. Conclusion The effect of epidural patient-controlled intravenous analgesia in elderly patients with less good, stress response, less adverse reaction, is worth the clinical promotion.