静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静舒适度及不良反应影响的比较研究

Comparison of the Effects of Intravenous and Epidural Controlled Analgesia on the Postoperative Sedation Comfort and Adverse Reactions in Elderly Patients Undergoing Total Hip Arthroplasty

目的:探讨与比较静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度及不良反应影响。方法:收集2016年1月至2017年9月入院的120例行髋关节置换术的老年患者随机分为两组,PCIA组患者予以PCIA镇痛处理,PCEA组患者则予以PCEA镇痛处理,比较两组患者各时段静息与活动状态下疼痛、镇静、舒适度、精神状态与不良反应。结果:PCEA组患者术后4h、8h、12h、24h与48h的静息状态VAS评分均显著性低于PCIA组;术后12h、24h与48h的活动状态VAS评分均显著性低于PCIA组;术后4h、8h、12h、24h与48h的RSS评分均显著性低于PCIA组,BCS评分均显著性高于PCIA组;术后24h与48h的MMSE评分均显著性高于PCIA组;恶心、呕吐发生率显著性低于PCIA组,差异有统计学意义(P<0.01);下肢乏力与导尿管留置时间过长发生率明显高于PCIA组,差异有统计学意义(P<0.05)结论:相比较PCIA,PCEA对老年髋关节置换术患者术后疼痛、镇静、舒适度与精神状态的效果更为优秀,但需要注意下肢乏力与导尿管留置时间过长等不良反应,具有借鉴意义。

Objective:To investigate and compare the effects of intravenous and epidural controlled analgesia on postoperative sedation,comfort and adverse reactions in elderly patients undergoing total hip arthroplasty.Methods:120 elderly patients undergoing hip arthroplasty admitted from January 2016 to September 2017 were randomly divided into two groups:PCIA group received PCIA analgesia and PCEA group received PCEA analgesia.Pain,sedation,comfort,mental state and adverse reactions in both groups at rest and activity at different time points were compared between the two groupos.Results:The resting VAS scores of patients in PCEA group at 4h,8h,24h and 48h after operation were significantly lower than those in PCIA group.The VAS scores at 12h,24h and 48h after operation were significantly lower than those in PCIA group.The scores of RSS at 4h,8h,12h,24h and 48h were significantly lower than that of PCIA group,and BCS score was significantly higher than that of PCIA group.MMSE scores at 24h and 48h after operation were significantly higher than those in PCIA group.Nausea and vomiting(P<0.01).The incidence of lower extremity weakness and prolonged urinary catheter indwelling time was significantly higher than that of PCIA group(P<0.05),and there was a significant difference Conclusion:Compared with PCIA,PCEA has better effect on postoperative pain,sedation,comfort and mental state in elderly patients undergoing hip replacement.However,attention should be paid to the side effects such as fatigue of the lower extremities and too long indwelling catheter.