摘要
目的:观察并比较两种不同镇痛方案在全髋关节置换术后的临床疗效。方法:选择2014年9月到2016年9月我院骨科行全髋关节置换术的患者30例,随机分为A组(硬膜外镇痛方案)和B组(关节周围"鸡尾酒"式镇痛方案),其中A组于伤口闭合后通过L2/3或L3/4椎间置管以灌注泵按4ml/h的速度持续注入2mg/ml罗哌卡因+0.8mL(10mg/mL)吗啡+0.9%生理盐水共100mL,B组将28.4mg罗哌卡因+0.8ml吗啡+0.3ml肾上腺素+2.5ml凯纷+15.4ml 0.9%生理盐水共60mL于髋关节周围软组织中注射,此外,A、B两组均结合多模式镇痛,观察比较两组患者术后镇痛评分、术后Ramsay镇静评分及不良反应发生情况,并调查患者满意度。结果:B组患者在术后12h和24h VAS镇痛评分均显著低于A组(P<0.05);B组患者在术后6h、12h、24h的Ramsay镇静评分均显著高于A组(P<0.05);B组不良反应总发生率为6.7%(1/15),显著低于A组(P<0.05);B组镇痛满意和很满意的患者为66.7%(10/15),显著高于A组53.3%(8/15)。结论:"鸡尾酒"式镇痛混合剂结合多模式镇痛较硬膜外镇痛结合多模式镇痛在缓解全髋关节置换术后疼痛的临床效果更显著,安全性更高,患者满意度更高,可优先选择。
Objective： To observe and compare the clinical efficacy of two different analgesia regimens after total hip arthroplasty. Methods： 30 patients underwent total hip arthroplasty in our hospital from September 2014 to September 2016 were collected and randomly divided into two group：A （Epidural Analgesia Program） and B （A ＂cocktail＂ type of analgesia around the joint）, In group A, 2 rag/ ml of ropivacaine ＋0.8 mL（10 mg/mL） of morphine＋0.9 saline with a total of volume of 100 mL was infused at the rate of 4 ml/h by L2/ 3 or L3/4 intervertebral cannula after wound closure; while group B received total 60mL volume of 28.4mg of ropivacaine＋0.8 mL of morphine＋0.3 mL of epinephrine＋2.5 mg/mL of Flurbi profen Axetil ＋15.4ml 0.9% saline in the soft tissue around the hip joint injection, in addition, A and B group were combined with multi-modal analgesia, the postoperative analgesic score, Ramsay sedation score and adverse reaction were observed and compared and the patient＇ s satisfaction was investigated. Results： The VAS analgesic scores of group B were significantly lower than those of group A at 12 h and 24 h after operation （P 〈0.05）; The sedation scores of group B were significantly higher than those of group A at 6 h, 12 h and 24 h after operation （P〈 0.05）. The total incidence of adverse reactions in group B was 6.7% （1/15）, which was significantly higher than that in group A （P〈0.05）; B group was 66.7% （10/15）And 53.3% （8/ 15） in group A, respectively. Conclusion： ＂Cocktail＂ type analgesic combination combined with muhimodal analgesia combined with epidural analgesia combined with multimodal analgesia is more effective and effective in relieving pain after total hip arthroplasty, with higher safety and higher patient satisfaction, can be preferred.
出处
《黑龙江医药》
CAS
2017年第4期749-752,共4页
Heilongjiang Medicine journal
基金
湛江市科技计划项目(项目编号:2015B01034)
