老年人后路腰椎椎间融合术后两种镇痛比较  

Comparison of two analgesic approaches secondary to posterior lumbar interbody fusion in the elderly

作　　者：牛宁奎[1] 杨宗强[1] 李旭生[1] 原文琦 陈霄雷 丁惠强[1] 施建党[1] NIU Ning-kui;YANG Zong-qiang;LI Xu-sheng;YUAN Wen-qi;CHEN Xiao-lei;DING Hui-qiang;SHI Jian-dang(Department of Spinal Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院脊柱骨科,宁夏银川市750004

出　　处：《中国矫形外科杂志》2020年第23期2113-2116,共4页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81860395);宁夏医科大学青年骨干人才培育计划项目(编号:30230103)。

摘　　要：[目的]比较高龄患者后路腰椎椎间融合术(posterior lumbar interbody fusion, PLIF)后两种镇痛的临床疗效。[方法]将2018年6月~2018年8月,80例年龄>65岁,拟行PLIF术的患者纳入本研究,随机分为两组。其中,浸润组40例术中在切口周围采用0.5%罗哌卡因由深至浅地对手术区域进行逐层局部浸润注射;镇痛泵组40例,于术前72h开始口服塞来昔布,术后静脉自控镇痛泵。比较两组患者术后视觉模拟评分法(VAS评分)、术后首次追加镇痛药时间、追加镇痛药物的用量、不良反应发生率及患者满意度。[结果]术后6~48 h,浸润组的VAS评分均显著小于镇痛泵组(P<0.05),术后72 h浸润组VAS评分仍低于镇痛泵组,但差异已无统计学意义(P>0.05)。浸润组患者术后首次追加镇痛药物时间显著长于镇痛泵组,追加镇痛药物的量及不良反应发生率显著少于镇痛泵组(P<0.05)。浸润组患者满意度显著高于镇痛泵组,差异有统计学意义(P<0.05)。[结论]高龄患者后路腰椎椎间融合术后,罗哌卡因在切口周围局部浸润的镇痛效果显著优于芬太尼静脉镇痛泵。[Objective] To compare the clinical efficacy of two analgesic approaches after posterior lumbar interbody fusion(PLIF) in the elderly. [Methods] From June 2018 to August 2018, a total of 80 patients who aged more than 65 years and were undergoing PLIF in our department were enrolled in this study and randomly divided into two groups. Of them, 40 patients in the local infiltration(LI) group received 0.5% ropivacaine infiltration injection from the deep to the superficial around the incision at end of the PLIF, while the remaining 40 patients in the patient controlled analgesia(PCA) group had oral administration of celecoxib 72 h before operation combined with fentanyl by intravenous pump postoperatively. The visual analogue scale(VAS) for pain, time to the first adding analgesics after surgery, the total dosage of additional analgesics, the incidence of adverse reactions and the satisfaction of patients were compared between the two groups. [Results] From 6 hours to 48 hours postoperatively, the LI group had significantly lower VAS score than the PCA group(P<0.05). At 72 hours postoperatively, the LI group still got lower VAS score than the PCA group, which became not statistically significant(P>0.05). The LI group had significantly longer time to the first adding analgesics(P<0.05), significantly lower total dosage of additional analgesics(P<0.05),and significantly lower incidence of adverse reaction than the PCA group(P<0.05). In addition, the LI group had significantly higher patient’s satisfaction to the analgesia than the PCA group(P<0.05). [Conclusion] The analgesic efficacy of local infiltration injection of ropivacaine is considerably superior to the patient controlled analgesia with intravenous fentanyl secondary to posterior lumbar interbody fusion in the elderly.

关 键 词：老年人 后路腰椎椎间融合 罗哌卡因 镇痛 

分 类 号：R687[医药卫生—骨科学]