超声引导下神经阻滞联合静脉自控镇痛在老年骨科手术加速康复中的应用

Application of ultrasound-guided nerve block combined with patient-controlled intravenous analgesia after orthopedic surgery in elderly patients analgesia for enhanced recovery after surgery

目的观察超声引导下神经阻滞联合静脉自控镇痛(PCIA)在老年骨科手术中的镇痛效果.方法选取老年下肢骨科手术患者72例,将其随机分为静脉自控镇痛(PCIA)组(Ⅰ组)、超声引导下单次注药神经阻滞镇痛+ PCIA组(Ⅱ组)、超声引导下置管持续注药神经阻滞镇痛+PCIA组(Ⅲ组),每组24例.在术后6、12、24、36、48 h时间点比较各组疼痛强度的VAS评分和舒芬太尼的用量,并观察患者术后不良反应和总体满意度.应用SPSS 16.0统计软件分析,计量资料采用单因素方差分析及Newman-keules检验;计数资料采用χ2检验.结果术后6、12、24、36 h时间点,各组舒芬太尼用量和VAS评分差异有统计学意义(P<0.01),其中Ⅰ组最高,Ⅲ组最低.各组术后不良反应发生率差异有统计学意义(χ2=9.333,P<0.01),其中Ⅰ组(45.83%)最高,Ⅲ组(8.33%)最低,各组总体满意度差异有统计学意义(χ2=6.799,P<0.05),其中Ⅱ组(66.67%)最高,Ⅰ组(29.16%)最低.结论应用超声引导下神经阻滞联合PCIA对老年患者下肢骨科手术后镇痛的效果良好,安全性高.

Objective To observe the effect of ultrasound-guided nerve block combined with patient-controlled intravenous analgesia(PCIA) as a postoperative analgesic method for elderly patients with lower limb orthopedic surgery. Methods Seventy-two elderly patients undergoing lower limb orthopedic surgery are randomly divided into three groups, each consisting of 24cases: patient-controlled intravenous analgesia(PCIA) group (group Ⅰ), ultrasound-guided single injection of nerve block analgesia + PCIA group (group Ⅱ), ultrasound-guided continuous injection of nerve block analgesia + PCIA group (group Ⅲ). The VAS scores of pain and the doses of sufentanil are compared at the 6th, 12th, 24th, 36th, and 48th hours after surgery, and the postoperative adverse reactions and overall satisfaction were observed. Results At the 6th, 12th, 24th, and 36th hours after operation, the differences in the doses of sufentanil and VAS scores between the groups are statistically significant (P<0.01), with the highest in group Ⅰ and the lowest in group Ⅱ. Differences in the incidence of adverse reactions between the groups are statistically significant (χ2=9.333, P<0.01), with the highest in group Ⅰ(45.83%) and the lowest in group Ⅲ(8.33%). Differences in the overall satisfaction between the groups are statistically significant (χ2=6.799, P<0.05), with the highest in group Ⅱ(66.67%) and the lowest in group Ⅰ(29.16%). Conclusion Being both effective and safe, ultrasound-guided nerve block combined with PCIA is an ideal postoperative analgesic method for elderly patients with lower limb orthopedic surgery.