静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度及并发症影响的比较  

Comparison of sedation effect,comfort degree and incidence of complications by PCIA and PCEA in elderly patients after hip replacement surgery

作　　者：鲁义[1] 屠伟峰[1] 卿朝晖[1] 卜文豪[1] 陆建华[1] 尧新华[2] 

机构地区：[1]南方医科大学附属广州军区广州总医院麻醉科,510010 [2]广州市中医医院麻醉科

出　　处：《临床麻醉学杂志》2015年第2期109-112,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金资助面上项目(编号:81371233)

摘　　要：目的探讨疼痛VAS评分≤2分时静脉与硬膜外自控镇痛对老年髋关节置换术患者术后镇静、舒适度以及并发症的影响。方法择期行腰-硬联合麻醉下髋关节置换术患者60例,男27例,女33例,年龄≥60岁,BMI 18.5~25.0kg/m2,术后12h的疼痛VAS评分≤2分,静脉自控镇痛(PCIA组)与硬膜外自控镇痛(PCEA组)各30例,采用Ramsay镇静评分(RSS)、舒适度评分(BCS)量表评估术后12、24h患者的镇静及舒适度,并观察术后并发症发生情况。于术后12h检测患者血清TNF-α与IL-6的含量。结果术后12、24hPCEA组的BCS评分分别为(3.37±0.67)和(3.73±0.45)分,明显高于PCIA组的(2.73±1.14)和(3.03±0.85)分(P<0.05);RSS评分分别为(2.17±0.53)和(2.03±0.18)分,明显低于PCIA组的(2.70±1.02)和2.40±0.81)分(P<0.05)。PCIA组恶心呕吐发生率明显高于PCEA组(P<0.05)。术后12h,PCEA组血清TNF-α与IL-6含量明显低于PCIA组(P<0.05)。PCEA组术后低血压、导尿管停留时间延长、下肢乏力或麻木的发生率明显高于PCIA组(P<0.05)。结论在疼痛VAS评分≤2分时,PCEA可提供更好的舒适度及镇静效果,但增加术后低血压、导尿管停留时间延长等并发症发生率。Objective To observe the differences of sedation effect, comfort degree as well as incidence of complications in elderly patients after hip replacement surgery undergoing epidural and in- travenous patient-controlled analgesia when VAS-~2. Methods Sixty patients aged over 60 years, in- eluding male 27 and female 33 with BMI 18.5-25.0 kg/m2, received hip replacement with epidural an- esthesia and whose visual analogue scale （VAS） not higher than 2 at postoperative 12 h were en- rolled. They were divided into PCIA and PCEA group with 30 patients in each group. Bruggrmann Comfort Scale （BCS） and Ramsay Sedation Score （RSS） were used to evaluate sedative effect and comfort degree in each group and incidences of complications were observed. The concentration of TNF-α and 1L-6 were detected at postoperative 12 h. Results Postoperative 12 h and 24 h BCS of groups PCEA and PCIA were（3.37±0. 67 vs. 2.73±1.14） and （3.73±0. 45 vs. 3.03±0. 85） （P〈 0.05）. Sedative effect were （2.17±0. 53 vs. 2.70±1.02） and （2.03±0.18 vs. 2.40±0.81） （P〈 0.05）. Incidence rates of nausea was lower in group PCEA （P〈0.05）. Incidence of low pressure, prolonged catheter retention and lower limb weakness or numbness were higher in group PCEA （P〈0. 05）. The concentration of TNF-α and IL-6 in group PCEA were lower than those in group PCIA at postoperative 12 h （P〈0. 05）. Conclusion PCEA may provide superior sedative effect and be more comfortable when VAS^2, while has more postoperative complications such as hypotension and pro- longed catheter retention.

关 键 词：静脉自控镇痛 硬膜外自控镇痛 视觉模拟评分 

分 类 号：R614[医药卫生—麻醉学]