酮咯酸氨丁三醇联合腰丛神经阻滞对老年患者髋关节置换术快速康复的影响

Effect of Ketorolac tromethamine and lumbar plexus block on rapid rehabilitation for hip arthroplasty in elderly patients

目的:研究酮咯酸氨丁三醇联合腰丛神经阻滞对老年患者髋关节置换术快速康复的影响。方法:选取2016年1月至2017年1月在我院择期行髋关节置换术的老年患者(≥60岁)60例,完全随机分为试验组30例,手术结束前30 min静注酮咯酸氨丁三醇30 mg;对照组30例,手术结束前30 min静注生理盐水5 m L,需要时单次追加吗啡1 mg静注。两组患者均予手术结束前行腰丛神经阻滞。比较两组患者术后VAS疼痛评分、对术后疼痛管理的满意度、术后肛门排气时间、术后并发症的发生率等。结果:与对照组相比,试验组患者的VAS评分在出麻醉恢复室前及出室后6 h有显著性降低(P<0.05);试验组的疼痛管理满意度评分(7.3±2.1)明显高于对照组(5.0±3.4)(P<0.05);需要阿片类药物次数,试验组(1.2±0.9)明显低于对照组(3.0±1.4)(P<0.05);术后肛门排气时间,试验组天数明显小于对照组(1.8±0.7vs 2.5±0.7,P<0.05)。结论:手术结束前静注酮咯酸氨丁三醇并联合腰丛神经阻滞的多模式镇痛可以为全髋关节置换手术的老年患者提供满意的术后镇痛,且不良反应少,促进术后康复,符合快速康复外科理念。

Objective： To investigate the effect of Ketorolac tromethamine and lumbar plexus block on the rapid rehabilitation for hip arthroplasty in elderly patients.Methods： Sixty elderly patients（ ≥60 years old）,who underwent elective hip arthroplasty in our hospital between January 2016 and January 2017,were randomly divided into the study group（ n = 30） and control group（ n = 30）.The study group received intravenous injection with 30 mg Ketorolac tromethamine at 30 min before the end of surgery. The control group received intravenous injection with 5 ml normal saline at 30 min before the end of surgery,and added with 1 mg morphine once by intravenous injection if necessary. Both groups were given lumbar plexus block at the end of surgery. The postoperative VAS pain scores,postoperative pain management satisfaction,postoperative anal exhaust time and incidence of postoperative complications were compared between the two groups. Results： Compared with the control group,the VAS scores in the study group significantly decreased at the baseline and at 6 h after exiting the anesthesia recovery room.The pain management satisfaction score in the study group was significantly higher than that in the control group [（ 7.3±2.1） vs（ 5.0±3.4）,（ P〈0.05） ]. The required medication times with opioids in the study group was significantly lower than that in the control group[（ 1.2±0.9） vs（ 3.0±1.4）,（ P〈0.05） ].The postoperative anal exhaust time in the study group was significantly less than that in the control group [（ 1. 8 ±0.7） d vs（ 2. 5 ± 0. 7） d,（ P〈0. 05） ]. Conclusion： Multimodal analgesia,such as intravenous injection with Ketorolac tromethamine and lumbar plexus block at the end of surgery,may provide satisfactory postoperative analgesia in elderly patients underwent total hip arthroplasty with less adverse reactions. It may promote postoperative recovery,which is consistent with the concept of rapid rehabilitation for surgery.