手术体积描计指数指导髋关节置换术中镇痛药使用的效果研究

Efficacy of perioperative usage of analgesic drugs under the guidance of surgical pleth index

目的观察手术体积描计指数(surgical pleth index, SPI)在髋关节置换术中指导镇痛药物使用的临床效果。方法选择髋关节置换的患者60例,年龄50~65岁,BMI 18.5~24.9 kg/m^2,ASAⅠ或Ⅱ级,随机分为两组:常规镇痛组(T组)和指数监控镇痛组(S组),每组30例。分别于患者入室时、术中电锯割断股骨头时、缝皮时、术后1 h和术后次日清晨监测患者的MAP、HR、SPI数值;于入室时、术后1 h和术后次日清晨记录镇痛满意度;记录术中及术后镇痛药的使用剂量。结果在术中电锯割断股骨头时、缝皮时和术后1 h T组MAP明显高于S组,HR明显快于S组(P<0.05)。术后1 h T组患者满意度明显低于S组(P<0.05)。围术期T组患者所需镇痛药物总量、SPI数值和术后追加镇痛药的病例数明显高于S组(P<0.05)。结论术中通过SPI指导使用镇痛药物,不仅能够提供有效的镇痛效果,由于可以做到按需给药,避免盲目追加阿片类药物,所以也减少了阿片类药物的使用剂量。

Objective To observe the effect of surgical pleth index on guiding the use of analgesic drugs in hip arthroplasty. Methods Sixty patients with hip replacement,aged 50-65 years,BMI 50-65 kg/m^2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups with 30 cases in each group: traditional analgesia group(group T) and index controlled analgesia group(group S). MAP, HR, and SPI were monitored when the patients entered the room, the femoral head was cut, the skin was sewn, and 1 hour after the operation and the next morning after the operation. Analgesic satisfaction was observed when patients entered the room, 1 hour after the operation and the next morning after the operation. In addition, the dosage of analgesics used during and after the operation was recorded. Results The MAP and HR in group T were significantly higher than those in group S during the operation and 1 hour after the operation(P < 0.05). The analgesic satisfaction of group S was significantly higher than that of group T 1 hour after the operation(P < 0.05). The total amount of analgesic drugs needed in group T during perioperative period and the number of patients with additional analgesic drugs after the operation were significantly higher than those in group S(P < 0.05). Conclusion Using analgesic drugs guided by SPI during the operation could provide effective analgesic efficacy, reduce the dosage of opioid drugs since it can be administered on demand and avoid adding opioids blindly.