摘要
目的:探讨腰硬联合麻醉结合氢吗啡酮硬膜外自控镇痛(PCEA)应用于老年膝关节置换患者的效果。方法:选择2021年3月—2022年3月大冶市人民医院收治的行膝关节置换术的80例老年患者,根据随机数表法划分成两组,各40例。两组均给予腰硬联合麻醉的方式干预,PCEA中,对照组给予舒芬太尼治疗,观察组给予盐酸氢吗啡酮治疗。对比两组的镇痛效果、镇痛泵按压次数、疾病疼痛程度、Ramsay评分、应激反应指标。结果:术前,两组肿瘤坏死因子-α(TNF-α)、去甲肾上腺素(NE)、皮质醇(Cor)水平比较,差异无统计学意义(P>0.05);术后24、72 h,观察组的NE、TNF-α、Cor水平明显低于对照组(P<0.05)。术后6、12、48、72 h,观察组的视觉模拟评分法(VAS)评分均低于对照组(P<0.05)。术后48 h,观察组镇痛泵按压次数少于对照组(P<0.05);术后24、48 h,两组Ramsay评分比较,差异无统计学意义(P>0.05)。术后,对照组发生呼吸抑制1例(2.50%),嗜睡1例(2.50%),恶心呕吐1例(2.50%),总发生率为7.50%(3/40);观察组术后出现嗜睡1例(2.50%),恶心呕吐1例(2.50%),总发生率为5.00%(2/40),两组的不良反应发生率比较,差异无统计学意义(χ^(2)=0.213,P=0.644)。结论:对老年膝关节置换术患者实施氢吗啡酮干预的镇痛疗效显著,可减少术后不良反应的发生,改善患者的应激反应指标水平,减少镇痛泵按压次数,改善Ramsay评分,适合应用于临床推广,具备较佳的推广价值。
Objective: To explore the effect of combined spinal epidural anesthesia and Hydromorphone patient-controlled epidural analgesia(PCEA) in elderly patients with knee replacement. Method: A total of 80 elderly patients who underwent knee arthroplasty in Daye People’s Hospital from March 2021 to March 2022 were selected, and they were divided into two groups according to random number table method, with 40 cases in each group. Both groups were given combined spinal epidural anesthesia, in PCEA,the control group was treated with Sufentanil, and the observation group was treated with Hydromorphone Hydrochloride. Compared the analgesic effect, the number of press of analgesia pump, the degree of disease pain, Ramsay score and stress response index between the two groups. Result: Before operation, there were no significant differences in the levels of tumor necrosis factor-α(TNF-α),norepinephrine(NE) and cortisol(Cor) between two groups(P>0.05). At 24 and 72 h after operation, the levels of NE, TNF-α and Cor in the observation group were significantly lower than those in the control group(P<0.05). At 6, 12, 48, 72 h after operation, the visual analogue scale(VAS) score in the observation group were lower than those in the control group(P<0.05). At 48 h after operation, the number of press of analgesia pump in the observation group was less than that in the control group(P<0.05). There were no significant differences in Ramsay score between the two groups at 24 and 48 h after operation(P>0.05). After operation, in the control group,respiratory depression occurred in 1 case(2.50%), lethargy in 1 case(2.50%), nausea and vomiting in 1 case(2.50%), and the total incidence was 7.50%(3/40);and there was 1 case(2.50%) of lethargy and 1 case(2.50%) of nausea and vomiting in the observation group after operation, with a total incidence of 5.00%(2/40), there was no statistically significant difference in the incidence of adverse reactions between the two groups( χ^(2)=0.213, P=0.644). Conclusion: The analgesic effect of Hydro
作者
夏洪锋
熊雄
石思思
王谦
XIA Hongfeng;XIONG Xiong;SHI Sisi;WANG Qian(Daye People's Hospital,Daye 435100,China;不详)
出处
《中外医学研究》
2023年第5期130-133,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
硬膜外自控镇痛
膝关节
腰硬联合麻醉
氢吗啡酮
老年膝关节置换术
Patient-controlled epidural analgesia
Knee joint
Combined spinal epidural anesthesia
Hydromorphone
Knee arthroplasty in the elderly
