优化镇痛对颈椎后路手术患者术后早期恢复质量的影响  

Effect of optimized analgesia on early postoperative recovery quality of patients undergoing cervical posterior approach surgery

作　　者：吴丽敏[1] 孟文君 侯涛 康芳 WU Lin-min;MENG Wen-jun;HOU Tao;KANG Fang(Department of Anesthesiology,the First Affiliated Hospital of USTC Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei,Anhui 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)麻醉科,安徽合肥230001

出　　处：《颈腰痛杂志》2023年第6期941-944,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：安徽省自然科学基金(编号:1908085MH251)。

摘　　要：目的观察优化镇痛模式对颈椎后路手术患者术后早期恢复质量的影响。方法纳入2020年6月~2021年3月择期经颈后路椎板切除减压融合内固定术患者68例,采用数字随机表法分为常规镇痛组(C组)和优化镇痛组(M组)各34例,C组术后行常规PCIA镇痛方案治疗;M组麻醉诱导前15 min静脉泵注右美托咪定0.6μg/kg,然后以0.3μg/kg/h的速度持续滴注直到开始皮肤缝合,切皮前给予帕瑞昔布钠40 mg,术毕0.375%罗哌卡因25 mL在切口周围逐层浸润,术后同C组行常规PCIA镇痛。采用QoR-15量表分别对患者术前1 d、术后1 d和3 d进行评分,记录患者术后6 h、12 h、24 h、48 h、72 h的VAS评分及补救镇痛情况;记录术后24 h、48 h舒芬太尼总消耗量、术后首次按压镇痛泵时间、镇痛满意度情况及术后相关不良反应的发生情况。结果与C组相比,M组术后1 d、3 d的QoR-15评分显著高于C组(P<0.05);M组患者术后6 h、12 h、24 h、48 h各时间点的VAS评分显著低于C组(P<0.05),术后补救镇痛使用率显著低于C组(P<0.05)。与C组相比,M组患者术后首次按压镇痛泵的时间明显延迟(P<0.05);M组术后24 h、48 h舒芬太尼的消耗量明显减少(P<0.05),且术后镇痛满意度显著提高(P<0.05);M组镇痛不良反应发生率显著低于C组(P<0.05)。结论采用优化镇痛模式可以显著改善颈椎后路手术患者术后急性疼痛,减少术后不良反应的发生,有利于提高患者术后早期恢复质量。Objective To observe the effect of optimized analgesia mode on early postoperative recovery quality of patients undergoing cervical posterior approach surgery.Methods A total of 68 patients with elective posterior cervical approach laminectomy decompression and internal fixation from June 2020 to March 2021 were included in this study and divided into two groups using digital random table method,the conventional analgesia group(group C)and the optimized analgesia group(group M),with 34 patients in the two groups,respectively.Group C received conventional PCIA analgesia after surgery.Group M was injected with dexmedetomidine 0.6 g/kg by intravenous pump 15 min before anesthesia induction,and then continued infusion at a rate of 0.3 g/kg/h until the start of skin suture.Parecoxibina 40mg was given before skin cutting,and 0.375%ropivacaine 25 mL was infiltrated layer by layer around the incision after surgery,PCIA analgesia was performed as in group C after surgery.The QoR-15 scale was used to score the patients 1 d before surgery,1 d after surgery and 3 d after surgery,respectively.The VAS scores at 6 h,12 h,24 h,48 h and 72 h after surgery and remedial analgesia were recorded.The total consumption of sufentanil at 24 h and 48 h after surgery,the time of the first pressure on the analgesia pump after surgery,the degree of satisfaction with analgesia and the incidence of postoperative adverse reactions were recorded.Results Compared with group C,the QOR-15 scores of group M at 1 d and 3 d after surgery were significantly higher than those of group C(P<0.05).The VAS score of group M at 6 h,12 h,24 h and 48 h after surgery was significantly lower than that of group C(P<0.05),and the utilization rate of postoperative remedial analgesia was significantly lower than that of control group(P<0.05).Compared with group C,the time of first pressing the analgesia pump in group M was significantly delayed(P<0.05).The consumption of sufentanil at 24 h and 48 h after surgery in group M significantly decreased(P<0.05),and the sati

关 键 词：颈椎后路 优化镇痛 罗哌卡因 帕瑞昔布钠 右美托咪定 术后早期恢复质量 

分 类 号：R687.3[医药卫生—骨科学]