连续股神经阻滞联合帕瑞昔布对老年髋部骨折手术患者术后应激反应及疼痛程度的影响  

Effects of CFNB combined with parecoxib on postoperative stress response and pain degree in elderly patients who underwent hip fracture surgery

作　　者：吴晓珲[1] 岳霞影[1] 冯睿[1] 陈文婷[1] WU Xiaohui;YUE Xiaying;FENG Rui;CHEN Wenting(Department of Anesthesiology,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海200021

出　　处：《临床与病理杂志》2021年第11期2550-2555,共6页Journal of Clinical and Pathological Research

摘　　要：目的:研究连续股神经阻滞(continuous femoral nerve block,CFNB)联合帕瑞昔布对老年髋部骨折手术患者术后应激反应及疼痛程度的影响。方法:选取2018年1月至2020年12月上海中医药大学附属曙光医院收治的80例行髋部骨折手术老年患者,根据治疗方式分为帕瑞昔布组(帕瑞昔布治疗)与CFNB组(帕瑞昔布组基础上联合CFNB治疗),各40例,比较两组的手术时间、住院时间、术中出血量、不同时刻[手术前(T_(1))、手术后(T_(2))、手术后24h(T_(3))]的疼痛视觉模拟量表(Visual Analogue Scale,VAS)和应激因子[丙二醛(MDA)、皮质醇(Cor)、醛固酮(ALD)]水平,记录两组患者术后不同时刻[手术后24 h(T_(3))、手术后48h(T_(4))、手术后72h(T_(5))]舒芬太尼用量和并发症发生情况。结果:CFNB组的住院时间短于帕瑞昔布组(P<0.05);各时间点CFNB组静止、运动状态VAS均低于帕瑞昔布组(P<0.05);两组MDA、Cor、ALD水平随时间推移逐渐上升,帕瑞昔布组上升幅度更明显(P<0.05);各时间点CFNB组的舒芬太尼用量少于帕瑞昔布组(P<0.05);CFNB组并发症发生率为17.50%,低于帕瑞昔布组的40.00%(P<0.05)。结论:CFNB联合帕瑞昔布应用于老年髋部骨折术后,可有效镇痛,缩短住院时间,减少应激反应和镇痛类药物用量,安全性较高。Objective:To study the effects of continuous femoral nerve block(CFNB)combined with parecoxib on postoperative stress response and pain degree in elderly patients who underwent hip fracture surgery.Methods:A total of 80 elderly patients undergoing hip fracture surgery who were admitted to the hospital from January 2018 to December 2020 were enrolled and randomly divided into a parecoxib group(parecoxib)and a CFNB group(CFNB combined with parecoxib)according to different treatment methods,with 40 cases in each group.The operation time,hospitalization time,and intraoperative blood loss,scores of Visual Analogue Scale(VAS)and levels of stress factors[malondialdehyde(MDA),cortisol(Cor),aldosterone(ALD)]at different time points[before surgery(T_(1)),after surgery(T_(2)),24 h after surgery(T_(3))]were compared between the two groups.The sufentanil dosage and occurrence of complications in both groups at different time points[T_(3),48 h after surgery(T_(4)),72 h after surgery(T_(5))]were recorded.Results:The hospitalization time in study group was shorter than that in the control group(P<0.05).The VAS scores of static and exercise status in the CFNB group were lower than that in the parecoxib group at different time points(P<0.05).The levels of MDA,Cor and ALD were increased in both groups,whose increase were more significant in parecoxib group than the CFNB group(P<0.05).The sufentanil dosage in CFNB group was less than that in parecoxib group at different time points(P<0.05).The incidence of complications in CFNB group was lower than that in parecoxib group(17.50%vs 40.00%)(P<0.05).Conclusion:The application of CFNB combined with parecoxib in the elderly after hip fracture surgery can effectively relieve pain,shorten hospitalization time,reduce stress response and dosages of analgesics,with high safety.

关 键 词：连续股神经阻滞 帕瑞昔布 髋部骨折 

分 类 号：R614[医药卫生—麻醉学]