连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛的效果  

Efficacy of continuous lumbar plexus block combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty

作　　者：王权光[1] 陈婵娟[1] 陈丽梅[1] 刘乐[1] 倪剑武[1] 张学政[1] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《中华麻醉学杂志》2012年第12期1441-1444,共4页Chinese Journal of Anesthesiology

基　　金：基金项目：温州市科技局对外合作项目基金（H20090013）;温州市科技计划项目基金（Y20100252）

摘　　要：目的评价连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛的效果。方法择期拟行髋关节置换术病人60例，性别不限，年龄51～75岁，体重47～77kg，身高150～181cm，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将其随机分为术后病人自控静脉镇痛组（PCIA组）和连续腰丛神经阻滞联合夜间单次加强术后镇痛组（CLPB组），每组30例。所有病人行腰麻，手术结束前30min，PCIA组病人上臂头静脉接病人自控静脉镇痛泵，药物配方：吗啡100mg＋生理盐水稀释至100ml，参数：首剂量0，持续量0，单次追加量2mg，锁定时间5min；CLPB组病人腰丛给予0．125％罗哌卡因30ml后接镇痛泵，药物配方为0．125％盐酸罗哌卡因，持续量8ml／h，单次追加量4ml，锁定时间30min，术后每晚8时追加0．25％罗哌卡因30m1。记录术后6、12、18、24、30、36、42和48h时病人静息及活动时VAS评分，观察恶心呕吐、瘙痒和尿潴留等不良反应的发生情况，随访总体满意情况，记录夜间由于疼痛导致睡眠中断次数和髋关节最大屈曲和外展活动度。结果与PCIA组比较，CLPB组病人运动时VAS评分、术后恶心呕吐、瘙痒、尿潴留严重程度和夜间由于疼痛导致睡眠中断次数降低，病人总体满意度、髋关节最大屈曲和外展活动度升高（P〈0．05）。结论与术后病人自控静脉镇痛相比，连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛效果好，且并发症少。Objective To evaluate the efficacy of continuous lumbar plexus block （CLPB） combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes, aged 51-75 yr, weighing 47-77 kg, with body height 150-180 cm, scheduled for hip arthroplasty, were randomized to receive either CLPB （group CLPB） or patient-controlled intravenous analgesia （PCIA） （PCIA group） for postoperative analgesia （ n = 30 each）. Spinal anesthesia was performed at L3.4 interspace. Postoperative analgesia was performed at 30 min before the end of surgery. PCIA solution contained morphine 100 mg in 100 ml of normal saline. The PCA pump was set up with a 2 mg bolus dose and a 5 min lockout interval. CLPB solution contained 0. 125 % ropivaeaine hydrochloride 200 ml. CLPB pump was set up to deliver a 4 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h after a loading dose of 0. 125% ropivacaine 30 ml. In addition the patients received 0.25 % ropivaeaine 30 ml at 8 o＇clock every night after surgery in group CLPB. VAS scores at rest and during activity were recorded at 6, 12, 18, 24, 30, 36, 42 and 48 h after operation. The side effect such as nausea and vomiting, pruritus and urinary retention were recorded within 48 h after operation. The patient＇ s satisfaction was assessed. The maximal hip flexion and abduction ranges of motion were recorded at 12, 24, 36 and 48 h after operation. The times of sleep interruption resulted from pain during nighttime were also recorded. Results Compared with group PCIA, the VAS scores during activity, severity of nausea and vomiting, pruritus and urinary retention, and times of sleep interruption resulted from pain during nighttime were significantly decreased, and the overall satisfaction score and maximal hip flexion and abduction ranges of motion were increased in group CLPB （ P 〈 0.05）. Conclusion CLPB combined with a bolus dose added at night can provide better e

关 键 词：腰骶丛 神经传导阻滞 关节成形术 置换 髋 镇痛 病人控制 

分 类 号：R614[医药卫生—麻醉学]