不同麻醉护理措施对术前行髂筋膜阻滞的高龄全髋关节置换术患者术后镇痛效果的影响

Effects of different anesthetic nursing measures on postoperative analgesia after preoperative iliac fascia block in elderly patients with total hip replacement

目的:观察不同麻醉护理措施对行髂筋膜阻滞的高龄全髋关节置换术患者术后镇痛效果的影响。方法:选择80例接受单侧人工髋关节置换术的高龄患者(年龄>70岁),随机分为围术期麻醉护理组(B组)和对照组(A组),每组40例。A组患者术前行超声引导下单次髂筋膜阻滞,术后施行常规麻醉护理;B组在A组护理措施的基础上,围麻醉期施行针对术后镇痛的麻醉护理干预,加强对术后镇痛的护理。观察两组患者在复苏期间患者的麻醉操作依从率、复苏时间;对比两组患者复苏期间开始活动患肢的时间及追加镇痛药物比例;术后疼痛视觉模拟评分法(VAS)评分、术后下床功能锻炼时间。结果:B组患者对麻醉操作的依从性高于A组患者(P<0.05);B组患者复苏期间追加镇痛药物比例及术后各时间点疼痛程度均明显低于A组(P<0.05),且复苏时间、复苏期间患肢活动时间及术后下床功能锻炼时间也早于A组患者(P<0.05)。结论:围麻醉期针对全髋置换术高龄患者加强术后镇痛的麻醉护理措施,可使患者在复苏期间及术后的镇痛效果更确切,促进患者早期进行功能锻炼,有利于术后康复。

Objective:To observe the effect of different anesthesia nursing measures on postoperative analgesia after iliac fascia block in elderly patients with total hip replacement.Methods:A total of 80 elderly patients who underwent unilateral hip replacement(age>70)were randomly divided into perioperative anesthesia nursing group(group B)and control group(group A),with 40 patients in each group.In group A,preoperative single iliac fascia block was performed through ultrasound guide,and routine anesthesia nursing was performed after operation.Based on nursing measures of group A,anesthesia nursing intervention was performed for postoperative analgesiaduring perianesthesia period and postoperative nursing care was strengthened in group B.The anesthesia compliance rate and recovery time during resuscitation between two groups were observed.The time to start moving the affected limb during resuscitation and the proportion of additional analgesics were compared between the two groups.Visual analogue scale(VAS)was used to test postoperative pain and postoperative functional exercise time.Results:The anesthesia compliance rate of group B was higher than that of group A(P<0.05).The proportion of additional analgesic during resuscitation and the degree of pain at each time point in group B were significantly lower than those in group A(P<0.05).The recovery time,affectedlimb movement time and functional exercise after operation in group B were earlier than those in group A(P<0.05).Conclusion:Anesthesia nursing measures for the elderly patients with total hip replacement during perianesthesia period can improve postoperative analgesia during recovery period and postoperative rehabilitation.