连续腰丛神经阻滞联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价

发布时间：2018-10-08 08:14

【摘要】：目的:比较连续腰丛神经阻滞(continuous lumbar plexus block,CLPB)联合多模式镇痛与患者静脉自控镇痛(patient controlled intravenous analgesia,PCIA)联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价。方法:68例单侧髋关节翻修的患者随机平均分成CLPB组与PCIA组。2组患者术前3 d使用帕瑞昔布钠镇痛;CLPB组术后经患侧腰丛神经周围置管处使用罗哌卡因镇痛,PCIA组术后经静脉使用曲马多加氟比洛芬酯镇痛,2组患者持续镇痛3 d,且术后加用帕瑞昔布钠镇痛直至运动时VAS评分3分。记录患者术后在静息及运动状态下的视觉模拟疼痛评分(visual analogue scale,VAS)、静脉注射帕瑞昔布钠用量、镇痛泵按压次数及不良反应。结果:CLPB组患者术后各时刻点在静息状态及运动状态下的VAS评分明显低于PCIA组(P0.05);CLPB组术后6、12、24 h在运动状态下的VAS评分分别为(2.50±0.71)、(3.59±0.99)、(3.67±1.01)分,明显低于对应时刻点的PCIA组:(4.97±0.94)分(P=0.00)、(4.85±0.86)分(P=0.00)、(4.32±0.73)分(P=0.00);镇痛泵按压次数及术后帕瑞昔布钠用量明显少于PCIA组(P0.05);不良反应发生率低于PCIA组。结论:CLPB联合多模式镇痛能有效缓解髋关节翻修术术后的早期疼痛,其术后镇痛效果优于PCIA,不良反应发生低,是髋关节翻修术较为理想的镇痛方案。
[Abstract]:Objective: to evaluate the effect of continuous lumbar plexus block (continuous lumbar plexus block,CLPB) combined with multi-mode analgesia (patient controlled intravenous analgesia,PCIA) and patient-controlled intravenous analgesia (patient controlled intravenous analgesia,PCIA) on postoperative analgesia after hip revision surgery. Methods Sixty-eight patients with unilateral hip revision were randomly divided into two groups: CLPB group and PCIA group. 2 patients were treated with paroxibum sodium for analgesia 3 days before operation. Tramadol plus flurbiprofen was administered intravenously for 3 days, and the postoperative analgesia was performed with paroxib sodium for 3 days, and the VAS score was 3 points at the time of exercise. The visual analogue pain score (visual analogue scale,VAS), the dosage of paroxib sodium intravenously, the times of analgesic pump compression and adverse reactions were recorded. Results the VAS scores in rest and exercise were significantly lower in the control group than in the PCIA group (P 0.05). The VAS scores in the exercise state were (2.50 卤0.71), (3.59 卤0.99), (3.67 卤1.01, respectively. The PCIA group was significantly lower than the corresponding time point group: (4.97 卤0.94), (P0. 00), (4. 85 卤0. 86) (P0. 00), (4. 32 卤0. 73) (P0. 00), the number of analgesic pump compressions and the amount of paroxib sodium after operation were significantly lower than those in the PCIA group (P0.05), and the incidence of adverse reactions was lower than that in the PCIA group (P < 0. 05). Conclusion the effect of PCIA, combined with the multimode analgesia is better than that of PCIA,. It is an ideal analgesic scheme for revision of hip joint.
【作者单位】：重庆医科大学附属第一医院麻醉科;
【基金】：国家临床重点专科建设项目经费资助项目(编号:2011-170) 重庆市医学重点学科建设经费资助项目(编号:2007-2)
【分类号】：R614

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