多模式镇痛联合超前镇痛在老年转子间骨折围术期疼痛控制中的应用效果分析  

Effect of multimodal analgesia combined with preemptive analgesia on perioperative pain control of elderly patients with femoral intertrochanteric fracture

作　　者：刘旭江[1] 朱亚妮[2] 蔡晓莉[1] 许舒娅[1] 

机构地区：[1]三峡大学中医临床医学院宜昌市中医医院,湖北宜昌443000 [2]湖北省十堰市东风总医院康复科,湖北十堰442000

出　　处：《实用临床医药杂志》2017年第7期50-54,共5页Journal of Clinical Medicine in Practice

基　　金：湖北省科技厅项目(TJG2015000011)

摘　　要：目的探讨多模式联合超前镇痛在老年转子间骨折围术期镇痛的应用效果及对睡眠质量的影响。方法选择股骨转子间骨折患者100例为处理组,另选取100例患者为对照组,处理组采用多模式联合超前镇痛方案,对照组为常规镇痛,比较2组患者术前48 h、24 h、术后24 h、3 d、1周、2周的VAS疼痛评分及使用曲马多的量。采用PSQI评分评价患者住院期间的睡眠质量,记录术后首次下地进行锻炼时间和术后住院时间,比较2组患者术后2周、3个月的髋关节Harris评分和不良反应。结果处理组各时点疼痛VAS评分显著低于对照组(P<0.05),对照组患者使用的曲马多量显著高于处理组(P<0.05)。对照组患者的PSQI评分显著高于处理组(P<0.05),术后首次下地锻炼时间显著长于处理组(P<0.05),处理组术后2周的髋关节Harris评分显著高于对照组(P<0.05)。术后3月髋关节Harris评分2组比较差异无统计学意义(P>0.05)。2组患者总不良反应发生率比较差异无统计学意义(P>0.05)。结论超前镇痛联合多模式镇痛在老年转子间骨折的围术期应用中具有良好的镇痛效果及安全性。Objective To explore the effect of multimodal analgesia combined with preemp- tive analgesia on perioperative pain control and sleep quality in elderly patients with intertrochanteric fracture. Methods A total of 100 elderly patients with femoral intertrochanteric factures were select- ed as treatment group, and 100 patients were selected as control group. The treatment group was trea- ted with multimodal analgesia and preemptive analgesia, while the control group was treated with the conventional analgesia. The VAS score and the amount of tramadol at preoperative 4 8 b, 2 4 h and 2 4 h, 3 d, 1 week, 2 weeks after operation were compared between the two groups. The sleep quality of pa- tients during hospitalization was evaluated by the PSQI score. The length of first time move for exer- cise and postoperative hospital stay were compared between two groups, and the postoperative Harris hip score at 2 weeks, 3 months after treatment and adverse reactions were compared. Results The treatment group had a lower YAS score at preoperative 48 h, 24 h and 24 h, 3 d, 1 week, 2 weeks after operation when compared with control group （ P 〈 0.05 ）. Tramadol dose in the control group was significantly higher than the treatment group （P 〈 0.05 ）, the PSQI score was significantly higher than the treatment group （P 〈 0.05 ）, the length of postoperative move for exercise was significantlylonger than the treatment group （ P 〈 0 . 0 5 ） . Harris hip score at 2 weeks after operation in the treatment group was significantly higher than that in control group （P 〈 0.05 ）, while 3 months after operation, the Harris hip score was similar between the two groups （P 〉 0.05 ）. The total incidence rate of adverse reactions were similar between the two groups （ P 〉 0.05）. Conclusion Appliea- tion of multimodal analgesia combined with preemptive elderly patients with femoral intertrochanteric fracture, hip joint function recovery of patients in early stage. analgesia is effective and safe in treatment of

关 键 词：多模式镇痛 超前镇痛 老年 转子间骨折 疼痛 

分 类 号：R683[医药卫生—骨科学]