不同镇痛方式对老年患者髋关节置换术后快速康复的影响

Effects of Different Analgesic Methods on Recovery after Surgery in Elderly Patients Undergoing Hip Replacement

目的观察不同镇痛方式对老年髋关节置换术患者术后快速康复的影响。方法择期行单侧全髋置换术老年患者80例,随机分为自控静脉镇痛组(PCIA组)和自控硬膜外镇痛组(PCEA组),每组各40例。术中所有患者均采用蛛网膜下腔阻滞麻醉,术后PCIA组采用静脉镇痛,镇痛泵配方为芬太尼0.8 mg+布托啡诺6 mg+昂丹司琼8 mg,加入生理盐水至总容量为100 mL;PCEA组采用硬膜外镇痛,镇痛泵配方为丁哌卡因125 mg+吗啡5 mg,加入生理盐水至总容量为100 mL。两组镇痛泵输注速度均为2 mL/h。术前1 h(T0),术后4 h(T1),6 h(T2),12 h(T3),24 h(T4)和48 h(T5)记录患者静态和动态模拟疼痛(VAS)评分、40项恢复质量评分量表(QoR-40)评分和PCA按压次数;观察并记录两组患者术后皮肤瘙痒和恶心呕吐的发生情况,同时采用B超监测下肢深静脉血栓形成(DVT)情况。结果PCEA组术后T1~T5时刻静态和动态VAS评分均较PCIA组低(P<0.05);PCIA组不同时刻动态VAS评分较静态VAS评分高(P<0.05)。与PCIA组相比,PCEA组患者T2~T5时刻情绪状态和身体舒适度评分明显升高(P<0.05),T1~T5时刻心理支持和疼痛评分显著增加(P<0.05)。T1~T5时刻PCEA组总评分较PCIA组高(P<0.05)。与PCIA组比较,T2~T5时刻PCEA组PCA按压次数显著减少(P<0.05)。术后PCEA组皮肤瘙痒发生率较PCIA组高(P<0.05)。PCEA组患者DVT和恶心呕吐发生率较PCIA组低(P<0.05)。结论老年髋关节置换术后镇痛采用PCEA,可改善术后疼痛控制,促进术后早期物理治疗,降低DVT并发症发生率,提高患者满意度。

Objective To observe the effects of different analgesic methods on recovery after surgery in elderly patients undergoing hip replacement.Methods 80 elderly patients undergoing unilateral total hip replacement were randomly divided into patient-controlled intravenous analgesia group(PCIA group)and patient-controlled epidural analgesia group(PCEA group),and 40 patients in each group.Subarachnoid block anesthesia was applied to all patients during operation.After surgery,the PCIA group was treated with intravenous analgesia.The analgesic pump formula was Fentanyl 0.8 mg+Butorphanol 6 mg+Ondansetron 8 mg,and normal saline was added to a total volume of 100 mL.The PCEA group was given epidural analgesia.The analgesic pump formula was Bupivacaine 125 mg+Morphine 5 mg,and normal saline was added to the total volume to 100 mL.The infusion speed of analgesia pumps in both groups was 2 mL/h.Static and dynamic VAS scores,QOR-40 scores and PCA press times were recorded at 1 h(T0)before surgery,and 4 h(T1),6 h(T2),12 h(T3),24 h(T4)and 48 h(T5)postoperatively.The occurrence of skin itching postoperatively,nausea and vomiting were recorded in two groups.At the same time,B-ultrasound was used to monitor deep venous thrombosis(DVT).Results The static and dynamic VAS scores of t1~t5 in PCEA group were lower than those in PCIA group(P<0.05).Dynamic VAS score in PCIA group was higher than static VAS score at different moments(P<0.05).Compared with the PCIA group,the emotional state and physical comfort scores of patients in the PCEA group at T2~T5 were significantly increased(P<0.05),and the psychological support and pain scores at T1~T5 were significantly increased(P<0.05).The total score of the PCEA group was higher than that of the PCIA group at T1~T5(P<0.05).Compared with the PCIA group,the number of PCA compressions in the PCEA group at T2~T5 was significantly reduced(P<0.05).The incidence of pruritus in PCEA group was higher than that in PCIA group(P<0.05).The incidence of DVT,nausea and vomiting was lower in PCEA group(P<0.05).Conclusion The epidural analgesia can improve postoperative pain control,promote early postoperative physical therapy,reduce the incidence of DVT complications and improve patient satisfaction.