地佐辛联合氟比洛芬酯超前镇痛对老年全髋关节置换术患者术后镇痛、凝血功能和认知功能的影响

Effect of flurbiprofen axetil combined with dezocine for preemptive analgesia on postoperative analgesia,cognitive function and blood coagulation in elderly patients undergoing total hip replacement

目的研究地佐辛复合氟比洛芬酯超前镇痛用于老年全髋关节置换术的效果及对术后镇痛、凝血功能和认知功能的影响。方法前瞻性将2017年1月至2020年1月首都医科大学附属北京同仁医院收治的拟行全髋关节置换术的老年患者68例纳入研究,采用随机数字表法分为对照组和联合组,各34例。对照组采用地佐辛进行超前镇痛,联合组患者给予地佐辛联合氟比洛芬酯超前镇痛。采用简明智能状态量表(MMSE)评估患者术前、术后12、24和72 h的认知功能。采用视觉模拟评分(VAS)评估患者术后2、4、8、12、24和48 h的疼痛程度。比较两组术前和术后24 h凝血功能。比较两组术后苏醒时间、拔管时间和术后24 h舒芬太尼用量。比较两组不良反应发生率。结果两组在术前、术后12、24和72 h各时间点MMSE评分比较,差异均无统计学意义(P>0.05)。联合组术后2、4、8、12、24及48 h各时间点VAS评分分别为(1.4±0.6)、(1.6±0.8)、(1.7±0.7)、(1.3±0.5)、(1.9±0.7)、(1.5±0.4)分,均明显低于对照组中相对应时间点VAS评分[(2.2±0.7)、(2.3±1.1)、(2.5±1.0)、(2.7±1.2)、(2.6±1.3)、(2.2±0.9)分],差异均具有统计学意义(P<0.05)。两组术后苏醒时间和拔管时间比较,差异无统计学意义(P>0.05)。联合组术后24 h内舒芬太尼用量(48.6±4.15)mL明显少于对照组(6.2±5.4)mL,差异有统计学意义(P<0.05)。两组术前和术后24 h凝血功能各指标比较,差异无统计学意义(P>0.05)。两组术后不良反应发生率比较(11.76%vs.14.71%),差异无统计学意义(P>0.05)。结论地佐辛联合氟比洛芬酯超前镇痛应用于老年髋关节置换术能有效提高术后镇痛效果,减少术后镇痛药物用量,不影响术后凝血功能和术后认知功能。

Objective To explore the effect of flurbiprofen axetil combined with dezocine for preemptive analgesia on postoperative analgesia,cognitive function and blood coagulation in elderly patients undergoing total hip replacement.Methods Sixty-eight cases of elderluy patients undergoing hip replacement in Beijing Tongren Hospital,Capital Medical University ranging from Juanary 2017 to Juanary 2020 were selected as the research subjects and then were randomly divided into combination group and contral group,34 cases in each group.Patients in combination group received intravenous injection of flurbiprofen axetil and dezocine,patients in contral group were given intravenous injection of dezocine.MMSE was used to assess the cognitive function before operation and 12,24,72 h after operation.VAS scores were used to assess postoperative analgesia at 2,4,8,12,24,48 h after operation.Coagulation function before and 24 h after operation were also compared.The recovery time,extubation time and the dosage of sufentanil within 24 h after surgery was compared,as well as postoperative side effect.Results There was no significant difference between the two groups on MMSE scores before and 12,24 and 72 h after operation(P>0.05).The VAS scores and at 2,4,8,12,24,48 h after operation in combination group were(1.4±0.6),(1.6±0.8),(1.7±0.7),(1.3±0.5),(1.9±0.7),(1.5±0.4)scores,significantly lower than those in control group at the same time[(2.2±0.7),(2.3±1.1),(2.5±1.0),(2.7±1.2),(2.6±1.3),(2.2±0.9)scores],and the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative recovery time and extubation time between the two groups(P>0.05).The dosage of sufentanil within 24 h after surgery used in the combination group was(48.6±4.15)mL less than that of the control group(6.2±5.4)mL,the difference was statistically significant(P<0.05).There was no significant difference in coagulation function between the two groups before and 24 h after operation(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(11.76%vs.14.71%,P>0.05).Conclusion Flurbiprofen axetil combined with dezocine for preemptive analgesia in elderly patients undergoing hip replacement has good postoperative analgesia,reduce the use of analgesic drugs,while has little effect on postoperative cognitive function and blood coagulation.