全髋关节置换术后患者自控硬膜外镇痛和鸡尾酒疗法的效果观察  

Analgesic effects of cocktail therapy and patient automatic controlled epidural analgesia after total hip replacement

作　　者：魏利[1] 田军[1] 

机构地区：[1]哈尔滨医科大学附属第二临床医院急诊创伤外科,150001

出　　处：《中国医师进修杂志》2016年第4期346-349,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨全髋关节置换术后患者自控硬膜外镇痛（PCEA）和鸡尾酒疗法（CT）对术后镇痛效果的影响.方法 选取择期行人工全髋关节置换术患者88例,按随机数字表法分为PCEA组和CT组,每组44例.比较两组术后静息状态及活动状态视觉模拟评分（VAS）、阿片类药物用量、出院时间、术后并发症、术后睡眠质量评分、髋关节活动度等.结果 PCEA组术后12、24、48 h静息状态和活动状态VAS均明显低于CT组[静息状态：（3.68±1.45）分比（4.23±1.14）分、（2.61±1.04）分比（3.92±1.23）分、（2.31±0.97）分比（3.56±1.21）分,活动状态：（4.54±1.63）分比（5.87±2.11）分、（3.51±0.94）分比（4.34±1.07）分、（3.01±0.95）分比（4.05±1.17）分],差异有统计学意义（P〈0.05）,而两组术后72 h和出院时VAS比较差异无统计学意义（P〉0.05）.PCEA组阿片类药物用量明显少于CT组[（9.58±5.35）mg比（11.27±4.48）mg],差异有统计学意义（P〈0.05）.CT组恶心呕吐、头痛头晕发生率明显低于PCEA组[20.45%（9/44）比45.45%（20/44）、4.55%（2/44）比13.64%（6/44）],差异有统计学意义（P〈0.05）.两组住院时间、术后睡眠质量评分和术后髋关节活动度比较差异均无统计学意义（P〉0.05）.结论 镇痛方案的选择不可仅根据住院时间而定,更推荐个体化治疗,根据患者的具体情况及需求,对于较少接触麻醉剂及有恶心倾向的患者应使用PCEA,对于慢性疼痛患者CT可能更为有效.Objective To discuss postoperative analgesia effect of patient automatic controlled epidural analgesia （PCEA） and cocktail therapy （CT） after total hip replacement. Methods Eighty-eighty patients of selective total hip replacement were selected, and the patients were divided into PCEA group and CT group by random digits table method with 44 cases each. The postoperative resting state and active state visual analogue score （VAS）, dosage of opioid, discharge time, postoperative complications, postoperative sleep quality score and hip joint mobility were compared between 2 groups. Results The resting state and active state VAS in PCEA group 12, 24 and 48 h after operation were significantly lower than those in CT group, resting state： （3.68 ± 1.45） scores vs. （4.23 ± 1.14） scores, （2.61 ± 1.04） scores vs. （3.92 ± 1.23） scores and （2.31 ± 0.97） scores vs. （3.56 ± 1.21） scores, active state：（4.54 ± 1.63） scores vs. （5.87 ± 2.11） scores, （3.51 ± 0.94） scores vs. （4.34 ± 1.07） scores and （3.01 ± 0.95） scores vs. （4.05 ± 1.17） scores, and there were statistical differences （P〈0.05）. But there were no statistical differences in VAS 72 h after operation and at discharge between 2 groups （P〉0.05）. The dosage of opioid in PCEA group was significantly lower than that in CT group：（9.58 ± 5.35） mg vs. （11.27 ± 4.48） mg, and there was statistical difference （P〈0.05）. The incidences of nausea vomiting and headache dizziness in CT group were significantly lower than those in PCEA group： 20.45% （9/44） vs. 45.45% （20/44） and 4.55% （2/44） vs. 13.64% （6/44）, and there were statistical differences （P〈0.05）. There were no statistical differences in length of hospital stay, postoperative sleep quality score and postoperative hip joint mobility between 2 groups （P〉0.05）. Conclusions Choice of analgesic regimen of choice should not be made only according to the length of hospital stay. Individualized treat

关 键 词：关节成形术 置换 髋 镇痛 硬膜外 鸡尾酒疗法 

分 类 号：R614[医药卫生—麻醉学]