老年髋部骨折围手术期应用镇痛指数指导多模式镇痛方案的临床价值  

Clinical value of applying pain tolerance index to guide multimodal analgesic regimen during the perioperative period in elderly hip fractures

作　　者：岳咚霖 蔡宁[1] 马行军[1] 代晨旭 张伟[1] Yue Donglin;Cai Ning;Ma Xingjun;Dai Chenxu;Zhang Wei(Department of Anesthesiology,Fuyang People′s Hospital,Fuyang 236000,China)

机构地区：[1]阜阳市人民医院麻醉科,阜阳236000

出　　处：《中国医师进修杂志》2024年第12期1139-1143,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨老年髋部骨折手术中应用镇痛指数(PTi)指导多模式镇痛的麻醉效果,分析其对术后恢复的影响。方法回顾性选取阜阳市人民医院2022年4月至2023年4月收治的老年髋部骨折患者100例为研究对象,均行髋关节置换术,按术中采用镇痛方式的不同分为两组,对照组(50例)术中予以常规镇痛方案,试验组(50例)术中予以PTi指导下的多模式镇痛方案,比较两组麻醉镇痛效果、手术前后血流动力学指标、炎性因子、视觉模拟量表(VAS)评分、髋关节功能及镇痛药物应用情况。结果试验组麻醉镇痛优良率高于对照组[96.00%(48/50)比82.00%(41/50)],差异有统计学意义(χ^(2)=5.00,P<0.05)。试验组手术开始、手术开始30 min、手术结束时平均动脉压、心率(HR)波动幅度小于对照组(P<0.05)。试验组术后1、3 d血清白细胞介素6、肿瘤坏死因子-α水平低于对照组(P<0.05)。试验组术后24、48、72 h静息、活动视觉模拟量表评分低于对照组(P<0.05)。试验组术后6周Harris问卷总分高于对照组[(85.93±3.22)分比(75.19±4.18)分],差异有统计学意义(P<0.05)。试验组术中丙泊酚、舒芬太尼用量及术后追加镇痛药物次数少于对照组[(430.61±20.09)mg比(475.58±23.17)mg、(33.24±8.11)μg比(42.90±9.64)μg、(1.54±0.31)次比(2.07±0.44)次],差异有统计学意义(P<0.01)。试验组恶心呕吐发生率低于对照组[2.00%(1/50)比14.00%(7/50)],差异有统计学意义(χ^(2)=4.89,P<0.05)。结论老年髋部骨折手术中应用PTi指导下的多模式镇痛临床效果确切,可维持血流动力学平稳,减轻术后炎性反应、疼痛程度,促进髋关节功能恢复,且具有一定的安全性。ObjectiveTo investigate the clinical value of applying pain tolerance index(PTi)to guide multimodal analgesic regimen during the perioperative period in elderly hip fractures.MethodsA total of 100 elderly patients with hip fracture admitted to Fuyang People′s Hospital from April 2022 to April 2023 were selected as the study objects.The patients were underwent hip replacement and were divided into two groups according to the different analgesic methods used during the operation.The control group(50 cases)was given routine analgesia during the operation,and the experimental group(50 cases)was given multimode analgesia under the guidance of PTi during the operation.The anesthetic analgesic effect,hemodynamic indexes,inflammatory factors,visual analogue scale(VAS)score,hip function and analgesic drug application were compared between the two groups.ResultsThe excellent rate of anesthesia and analgesia in the experimental group was higher than that in the control group:96.00%(48/50)vs.82.00%(41/50),there was statistical difference(χ^(2)=5.00,P<0.05).The fluctuation ranges of mean arterial pressure(MAP)and heart rate(HR)at the beginning of operation,30 min after operation and the end of operation in the experimental group were lower than those in the control group(P<0.05).The serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the experimental groups were lower than those in the control group at 1 and 3 d after operation(P<0.05).The scores of VAS at 24,48 and 72 h after operation in the experimental group were lower than those in the control group(P<0.05).The total scores of Harris questionnaire in the experimental group was higher than that in the control group at 6 weeks after operation:(85.93±3.22)scores vs.(75.19±4.18)scores,there was statistical difference(P<0.05).The intraoperative dosage of propofol and sufentanil and the number of postoperative analgesic drugs in the experimental groups were lower than those in the control group:(430.61±20.09)mg vs.(475.58±23.17)mg,(33.24±8.11)μg

关 键 词：关节成形术 置换 髋 麻醉和镇痛 镇痛指数 老年人 

分 类 号：R614[医药卫生—麻醉学]