智能调节背景剂量患者自控静脉镇痛对髋关节置换术后镇痛效果的影响

Effects of PCIA with intelligently regulated background infusionon on postoperative analgesia in patients undergoing hip replacement

目的分析地佐辛复合氟比洛芬酯用于智能调节背景剂量和恒定背景剂量患者自控静脉镇痛(PCIA)对腰硬联合麻醉下单侧髋关节置换术后镇痛效果的影响。方法回顾分析2016-01/2019-12期间我院单侧髋关节置换术后镇痛患者80例,术后以地佐辛0.6~0.7 mg/kg+氟比洛芬酯2~3 mg/kg+生理盐水至120 mL行PCIA。根据是否使用智能调节背景剂量镇痛泵将患者分为2组,智能调节背景剂量组(IB组,n=40)和恒定背景剂量组(CB组,n=40)。比较镇痛开始后4、 8、 24和48 h数字评分法(NRS)评分、 Ramsay镇静评分,自控按压次数、镇痛不良反应和镇痛总体满意度。结果与CB组相比, IB组在镇痛后24 h和48 h活动和静息NRS评分显著升高(P<0.05),镇痛后24 h和48 h时Ramsay镇静评分显著降低(P<0.05), 24 h和48 h有效按压次数和总按压次数显著升高(P<0.05),镇痛药物累积消耗量显著降低(P<0.05),总体满意度无统计学意义(P>0.05)。IB组镇痛补救3例(7.5%),与CB组1例(2.5%)比较,差异无统计学意义(P>0.05)。恶心呕吐例数分别为IB组4例(10.0%)和CB组9例(22.5%), 2组间比较有统计学意义(P<0.05)。结论地佐辛复合氟比洛芬酯用于单侧髋关节置换PCIA时,智能调节背景剂量相比恒定背景剂量镇痛效果相当,但不良反应更低,有更好的应用前景。

Objective To investigate the efficacy of patient-controlled intravenous analgesia(PCIA)with intelligently regulated or constant background infusion of dezocine plus flurbiprofen axetil injection on postoperative analgesia in patients undergoing unilateral hip replacement.Methods Eighty patients undergoing unilateral hip replacement with combined spinal and epidural anesthesia,in our hospital from January 2016 to December 2019,were included and divided into two groups according to whether to use intelligently regulated pump,intelligently regulated background group(group IB,n=40)and constant background group(group CB,n=40).All patients were intravenously administered a PCA pump containing dezocine 0.6-0.7 mg/kg,flurbiprofen axetil 2-3 mg/kg and normal saline in a volume of 120 mL.NRS scores,Ramsay sedation scores,pressing times,consumption of analgesic,supplementary analgesics,the incidence of adverse reactions,and patients satisfaction scores were recorded after at 4 h,8 h,24 h and 48 h after the PCIA pumps were used. Results Compared with group CB,the NRS scores in group IB were higher at 24 h and 48 h during movement as well as rest(P<0.05).The Ramsay sedation scores in group IB were lower at 24 h and 48 h after the PCIA pumps were used(P<0.05).The effective pressing times and total pressing times in group IB were higher at 24 h and 48 h after the PCIA pumps were used(P<0.05),the consumption of analgesics in group IB were lower(P<0.05).No statistical difference was found in the satisfaction scores(P>0.05).The incidences of using supplementary analgesics were 7.5%(3 cases)in group IB and 2.5%(1 case)in group CB,and there is no statistical difference(P>0.05).The incidences of nausea and vomiting were 10%(4 cases)in group IB and 22.5%(9 cases)in group CB,there is statistical difference between two groups(P<0.05).Conclusion PCIA with intelligently regulated and constant background infusion of dezocine plus flurbiprofen axetil injection produce similar analgesic effects in patients undergoing unilateral hip replacement,while having lower incidence of adverse reactions and better application prospect.