多药联合应用超前镇痛促进骨科下肢日间手术患者术后快速康复的临床研究

Clinical Study of Multi-Drug Combination Application of Preemptive Analgesia in Promoting Rapid Postoperative Recovery of Patients Undergoing Lower Limb Daytime Operation in Orthopedics

目的:探讨多药联合应用超前镇痛促进骨科下肢日间手术患者术后快速康复的临床效果。方法:选取2018年8月至2020年6月于湘南学院附属医院行骨科下肢日间手术治疗的患者150例,按照随机数字表法分为对照组和观察组,每组75例。所有患者均采取椎管内麻醉,术后经静脉自控镇痛;在此基础上,观察组患者进行多药联合超前镇痛。观察两组患者的术后镇痛情况、镇静情况、生命指标、术后恶心呕吐(postoperation nausea and vomiting,PONV)发生情况、镇痛药使用量及术后住院时间。结果:观察组患者术后2、6、12和24 h的疼痛视觉模拟评分较对照组明显更低,术后2、6 h的Ramsay镇静评分较对照组明显更高,差异均有统计学意义(P<0.05);观察组患者术后12、24 h的Ramsay镇静评分与对照组比较,差异均无统计学意义(P>0.05)。两组患者术后2、6、12和24 h的收缩压、舒张压、心率及脉搏血氧饱和度测定值比较,差异均无统计学意义(P>0.05)。观察组患者PONV发生率为5.33%(4/75),较对照组的22.67%(17/75)明显更低,差异有统计学意义(P<0.05)。观察组患者术后24 h镇痛药曲马多用量较对照组明显更少,术后住院时间较对照组明显更短,差异均有统计学意义(P<0.05)。结论:对骨科下肢日间手术患者进行多药联合超前镇痛,可起到良好的镇痛、镇静效果,同时能够降低PONV发生率,减少镇痛药用量,有效促进患者术后康复。

OBJECTIVE:To probe into the clinical effects of multi-drug combination application of preemptive analgesia in promoting rapid postoperative recovery of patients undergoing lower limb daytime operation in orthopedics.METHODS:Totally 150 patients undergoing lower limb daytime operation in orthopedics of Affiliated Hospital of Xiangnan University from Aug.2018 to Jun.2020 were extracted to be divided into the control group and the observation group via the random number table,with 75 cases in each group.All patients were treated with intraspinal anesthesia and postoperative intravenous self-controlled analgesia.On this basis,the observation group received multi-drug combination application of preemptive analgesia.Postoperative analgesia,sedation,vital indicators,incidence of postoperative nausea and vomiting(PONV),dosage of analgesics and postoperative length of stay were observed in both groups.RESULTS:The visual analogue scale(VAS)score of the observation group was lower than that of the control group at 2,6,12 and 24 h after operation,the Ramsay score at 2 and 6 h after operation was higher than that of the control group,with statistically significant difference(P<0.05).There was no significant difference between two groups in the Ramsay score at 12 and 24 h after operation(P>0.05).There was no significant difference in systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and pulse oxygen saturation(SpO 2)between two groups at 2,6,12 and 24 h after operation(P>0.05).The incidence of PONV in the observation group was 5.33%(4/75),significantly lower than 22.67%(17/75)in the control group,and the difference was statistically significant(P<0.05).The dosage of analgesics tramadol at 24 h after operation in the observation group was less than that in the control group,the postoperative length of stay was shorter than that of the control group,with statistically significant difference(P<0.05).CONCLUSIONS:Multi-Drug combination application of preemptive analgesia for patients undergoing lower limb daytime operation in orthopaedics can achieve good analgesic and sedative effects,reduce the incidence of PONV,decrease the dosage of analgesics and effectively promote the recovery process of patients after operation.