【摘要】：[目的]探討攜帶利多卡因局部鎮(zhèn)痛泵在全髖關(guān)節(jié)置換術(shù)后鎮(zhèn)痛中的療效。[方法]將60歲以上初次全髖關(guān)節(jié)置換病例分為兩組,一組術(shù)后傷口放置局部鎮(zhèn)痛泵持續(xù)緩釋利多卡因(局部鎮(zhèn)痛泵組),一組術(shù)后使用靜脈鎮(zhèn)痛泵(patient controlled intra-venous analgesia,PCIA)輸入稀釋芬太尼(PCIA組)。比較兩組術(shù)后靜息疼痛視覺模擬評(píng)分(visual analogue scale,VAS);傷口延期愈合率、感染率;頭暈、惡心、嘔吐、尿潴留發(fā)生率;鎮(zhèn)痛泵依從性比率。[結(jié)果]局部鎮(zhèn)痛泵組術(shù)后1h VAS評(píng)分高于靜脈鎮(zhèn)痛泵組(P=0.016),術(shù)后2 h VAS評(píng)分與PCIA組相比差異無統(tǒng)計(jì)學(xué)意義(P=0.510),局部浸潤(rùn)組術(shù)后24 h(P=0.024)、48 h(P=0.012)VAS評(píng)分低于靜脈鎮(zhèn)痛組,差異有統(tǒng)計(jì)學(xué)意義。術(shù)后3 h后局部鎮(zhèn)痛泵組應(yīng)用額外鎮(zhèn)痛藥比例低于PCIA組(P=0.015),局部鎮(zhèn)痛泵者依從性優(yōu)于PCIA組(P0.001)。局部鎮(zhèn)痛組術(shù)后頭暈、惡心、嘔吐、尿潴留發(fā)生率均低于靜脈鎮(zhèn)痛組,差異有統(tǒng)計(jì)學(xué)意義;傷口延期愈合率兩組差異無統(tǒng)計(jì)學(xué)意義;兩組均無傷口感染。[結(jié)論]對(duì)于老年全髖關(guān)節(jié)置換患者,局部鎮(zhèn)痛泵持續(xù)靜息鎮(zhèn)痛效果優(yōu)于PCIA泵,能明顯減少患者頭暈、惡心、嘔吐、尿潴留發(fā)生率;全身麻醉患者,局部鎮(zhèn)痛泵應(yīng)用時(shí)如果配合術(shù)中傷口局部浸潤(rùn)麻醉或者術(shù)后早期輔助額外小劑量鎮(zhèn)痛藥物鎮(zhèn)痛效果可能更加理想。
[Abstract]:Objective: to investigate the effect of local analgesic pump carrying lidocaine on postoperative analgesia after total hip arthroplasty. [methods] the first total hip replacement patients over 60 years old were divided into two groups: one group was treated with local analgesic pump sustained release lidocaine (local analgesia pump group), the other group was treated with intravenous analgesia pump (patient controlled intra-venous analgesia, after operation. PCIA) was injected with diluted fentanyl (PCIA group). The visual analogue score (visual analogue scale,VAS) of postoperative resting pain, rate of delayed healing, infection rate, incidence of dizziness, nausea, vomiting, urinary retention and compliance ratio of analgesia pump were compared between the two groups. [results] the VAS score in the local analgesia pump group was higher than that in the intravenous analgesia pump group at 1 h after operation (P0. 016). The VAS score at 2 h after operation was not significantly different from that in the PCIA group (P0. 510), and that in the local infiltration group was 24 h after operation (P0. 024). 48 h (P0. 012) VAS score was lower than that of intravenous analgesia group (P 0. 012). 3 hours after operation, the proportion of extra analgesic in the local analgesic pump group was lower than that in the PCIA group (P0. 015), and the compliance of the local analgesic pump group was better than that of the PCIA group (P0. 001). The incidence of dizziness, nausea, vomiting and urinary retention in the local analgesia group was lower than that in the intravenous analgesia group, the difference was statistically significant; there was no significant difference in wound healing rate between the two groups; there was no wound infection in both groups. [conclusion] for elderly patients with total hip replacement, local analgesia pump is superior to PCIA pump for continuous resting analgesia, which can significantly reduce the incidence of dizziness, nausea, vomiting and urinary retention. In patients with general anesthesia, the analgesic effect of local analgesic pump may be better if it is combined with intraoperative wound infiltration anesthesia or early postoperative small dose analgesic drugs.
【作者單位】： 武漢市江夏區(qū)第一人民醫(yī)院骨科;華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬普愛醫(yī)院骨科;
【分類號(hào)】：R687.4

【共引文獻(xiàn)】

相關(guān)期刊論文 前4條

1 羅琴;楊軍;;硬膜外自控鎮(zhèn)痛在老年骨科手術(shù)患者中的鎮(zhèn)痛效果及對(duì)其術(shù)后應(yīng)激的影響[J];海南醫(yī)學(xué)院學(xué)報(bào);2014年02期

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3 朱劍熹;李康華;;雞尾酒療法治療全髖關(guān)節(jié)置換患者術(shù)后疼痛效果的meta分析[J];中國現(xiàn)代醫(yī)學(xué)雜志;2014年16期

4 謝佳芯;周琦;付奇?zhèn)?丁U喨，

本文編號(hào)：2384543