摘要
目的观察舒芬太尼静脉自控镇痛联合前路腰方肌阻滞对老年全髋关节置换患者术后疼痛、术后谵妄的影响。方法选择2016年1月至2019年6月安徽理工大学第一附属医院择期行髋关节置换术患者68例,年龄65~80岁,体质量50~80 kg,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,采用随机数字表法,将其随机分为2组:对照组(N组)和腰方肌阻滞组(R组)。手术结束后R组患者患侧在超声引导下行前路腰方肌阻滞,注射0.375%罗哌卡因30 mL,N组不进行腰方肌阻滞,两组患者接舒芬太尼镇痛泵行静脉自控镇痛(PCIA)。术后6 h(T1)、12 h(T2)、24 h(T3)、和48 h(T4),记录两组患者静态视觉模拟疼痛评分及运动VAS评分;记录术后48内各时段内舒芬太尼用量;不良反应发生率以及术后次日晨检测患者血清炎性指标;比较两组患者6 h(T1)、24 h(T3)、和48 h(T4),72 h(T5)内对患者谵妄发生的影响。结果前路腰方肌阻滞组(R组)与对照组(N组)比较,R组静态视觉模拟疼痛评分(VAS),运动VAS评分各时间点均低于N组,差异具有统计学意义(P<0.05),术后各时段内舒芬太尼用量R组低于N组,差异有统计学意义(P<0.05);不良反应发生率R组同N组未见明显差异(P>0.05),两组患者血清炎性指标值差异明显,差异有统计学意义(P<0.05);两组患者术后72 h内患者谵妄发生率R组低于N组,差异有统计学意义(P<0.05)。结论前路腰方肌阻滞复合静脉自控用于对老年髋关节术后镇痛效果优于单纯静脉自控镇痛(PCIA),减少术后炎症反应,并且减少72 h内患者术后谵妄的发生。
Objective To observe the effect of sufentanil intravenous controlled analgesia combined with quadratus lumborum block on postoperative pain and postoperative delirium in elderly patients with total hip arthro⁃plasty.Methods From January 2016 to June 2019,68 patients with hip arthroplasty were selected for the hip fracture in the First Affiliated Hospital of Anhui University of Science and Technology,whose age ranging from 65 to 80 years old,the body mass between 50 to 80 kg,and the Association(ASA)gradedⅠtoⅢ,were randomly divided into two groups:the control group(group N)and the quadratus lumborum block group(group R)using a random number table method.At the end of the operation,the patients in the group R underwent ultrasound⁃guided anterior quadratus lumborum block with injection of 0.375%ropivacaine 30 mL.Group N did not receive quadratus lumborum block,and patients in the two groups received sufentanil analgesia pump for intravenous controlled analgesia(PCIA).12 h(T2),24 h(T3),and 48 h(T4)after surgery,the static visual analogue pain score and motor VAS score were recorded in the two groups.The dosage of sufentanil was recorded within 48 hours after operation.The incidence of adverse reactions and serum inflammatory indicators were detected the following morning.The effects of 6 h(T1),24 h(T3),48 h(T4)and 72 h(T5)on delirium were compared between the two groups.Results Compared with the control group(group N),the static visual analogue pain score(VAS)and the motor VAS score in the group R were lower than those in the group N at all time points,and the difference was statistically significant(P < 0.05). The dose of sufentanil in the group R during each postoperative period was lower than that in the group N,and the difference was statistically significant(P < 0.05). Within 48 h,the number of cases requiring salvage analgesia in group R was lower than that in group N,with statistically significant difference (P < 0.05). There was no significant difference in the incidence of adverse reactions between gr
作者
石军
刘明红
薛敏
邱家洋
柴小青
SHI Jun;LIU Minghong;XUE Min;QIU Jiayang;CHAI Xiaoqing(Department of Anesthesia,the First Affiliated Hospital of Anhui University of Science and Technology,Huainan 232007,China)
出处
《实用医学杂志》
CAS
北大核心
2020年第3期334-338,共5页
The Journal of Practical Medicine
基金
2018年安徽省重点研究与开发计划项目(编号：1804h08020286)
关键词
腰方肌阻滞
老年人
髋关节手术
术后镇痛
术后谵妄
quadratus lumborum block
the elderly
hip surgery
postoperative analgesia
postop⁃erative delirium
