摘要
目的评价超声引导下腰方肌阻滞联合纳布啡对老年患者全髋关节置换术患者术后镇痛的临床效果。方法择期行腰硬联合麻醉下全髋关节置换术的老年患者120例，年龄65-80岁，采用随机数字表法将所有患者随机分为两组（n=60）：对照组（C组）和腰方肌阻滞组（Q组）。两组患者术中均采用腰硬联合麻醉，术毕Q组患者患侧在超声引导下行腰方肌阻滞，注射0．33％罗哌卡因30ml，C组不进行腰方肌阻滞。两组患者接舒芬太尼镇痛泵行患者自控静脉镇痛（PCIA）。患者术后每24h予以纳布啡5mg静脉注射联合神经阻滞进行多模式镇痛，共48h。分别于术后即刻（Tn）、术后3h（T1）、6h（T2）、12h（T3）、24h（T4）、36h（T5）和48h（T6）时记录患者静态视觉模拟评分法（VAS）评分；分别于T4～T6时记录患者运动VAS评分。统计术后24h和48h时两组患者需要使用静脉镇痛泵进行补救性镇痛的例数；记录两组患者术后不良反应和总体满意度。结果与C组比较，Q组患者于T1-T6时的静态VAS评分和L—L时的运动VAS评分均明显降低（均P〈0．05）。与C组比较，Q组患者术后24h和48h时需要使用静脉镇痛泵进行补救性镇痛的比例（56例比6例、57例比10例、57例比10例）均明显降低（均P〈0．05）。与C组比较，Q组患者呕心、呕吐和瘙痒发生率（23．3％比3．3％、20．0％比3．3％）均明显降低（均P〈0．05），而总体满意度（98．3％比80．0％）则升高（P〈0．05）。结论超声引导下经腰方肌阻滞联合纳布啡用于老年全髋关节置换术患者进行多模式镇痛，镇痛效果佳，不良反应发生率低。
Objective To investigate the clinical efficacy of quadratus lumborum block guided by ultrasound combined with nalbuphine for postoperative analgesia in elderly patients undergoing total hip arthroplasty. Methods One hundred and twenty 65-80 ears old patients, scheduled for total hip arthroplasty, were randomly divided into a control group （group C） and a quadratus lumborum block （group Q）two groups using random number table method, 60 for each group. Both groups took spinal-epidural anesthesia. Group Q took quadratus lemborum block guided by ultrasound within 30 min after operation and were injected 30 ml 0.33% ropivacaine. Then sufentanil patient-controlled analgesia pumpd were connected to all the patients in both groups. Multimodal analgesia was performed by nalbuphine 5 mg iv and quadratus lumborum block every 24 h after operation for 48 h. The rest and active exercise visual analogue scale （VAS） scores were recorded when the surgery was over （T0） and 3 （T1）, 6 （T2）, 12 （T3）, 24 （T4）, 36 （T5）, and 48 h （T6） after operation. The number of cases who needed remedial analgesia by PCIA was determined. The development of adverse reactions during blockade and overall satisfaction were recorded in the two groups. Results Compared with group C, the rest VAS scores at T1- T6 and active exercise VAS scores at T4-T6 were significantly lower （P〈0.05） in group Q. Compared with C group, fewer cases needed remedial analgesia by PCIA （P〈0.05） in Q group （56 cases vs. 6 cases, 57 cases vs. 10 cases, and 57 cases vs. 10 cases）. Compared with group C, the incidences of nausea and vomiting and pruritus were lower （P〈O.05, 23.3% vs. 3.3% and 20.0% vs. 3.3%） but the overall satisfaction score was higher （P〈O.05） in Q group （98.3% vs. 80.0%）. Conclusion Multimodal analgesia constituted of quadratus lumborum block guided by ultrasound combined with nalbuphine iss effective and provides satisfactory postoperative analgesia in elderly patients undergoing total hip
作者
彭栋梁
王晓娜
杨军
Peng Dongliang, Wang Xiaona, Yang Jun(Department of Anesthesiology, Third Hospital, Henan University of Traditional Chinese Medicine, Zhengzhou 450003, Chin)
出处
《国际医药卫生导报》
2018年第6期843-847,共5页
International Medicine and Health Guidance News
关键词
腰方肌阻滞
超声引导
纳布啡
多模式镇痛
全髋关节置换术
老年患者
Quadratus lumborum block
Ultrasound guided
Nalbuphine
Multimodal analgesia
Total hip arthroplasty
Elderly patients
