老年患者全髋关节置换术后携带利多卡因局部镇痛泵的疗效

发布时间：2018-12-17 17:15

【摘要】：[目的]探讨携带利多卡因局部镇痛泵在全髋关节置换术后镇痛中的疗效。[方法]将60岁以上初次全髋关节置换病例分为两组,一组术后伤口放置局部镇痛泵持续缓释利多卡因(局部镇痛泵组),一组术后使用静脉镇痛泵(patient controlled intra-venous analgesia,PCIA)输入稀释芬太尼(PCIA组)。比较两组术后静息疼痛视觉模拟评分(visual analogue scale,VAS);伤口延期愈合率、感染率;头晕、恶心、呕吐、尿潴留发生率;镇痛泵依从性比率。[结果]局部镇痛泵组术后1h VAS评分高于静脉镇痛泵组(P=0.016),术后2 h VAS评分与PCIA组相比差异无统计学意义(P=0.510),局部浸润组术后24 h(P=0.024)、48 h(P=0.012)VAS评分低于静脉镇痛组,差异有统计学意义。术后3 h后局部镇痛泵组应用额外镇痛药比例低于PCIA组(P=0.015),局部镇痛泵者依从性优于PCIA组(P0.001)。局部镇痛组术后头晕、恶心、呕吐、尿潴留发生率均低于静脉镇痛组,差异有统计学意义;伤口延期愈合率两组差异无统计学意义;两组均无伤口感染。[结论]对于老年全髋关节置换患者,局部镇痛泵持续静息镇痛效果优于PCIA泵,能明显减少患者头晕、恶心、呕吐、尿潴留发生率;全身麻醉患者,局部镇痛泵应用时如果配合术中伤口局部浸润麻醉或者术后早期辅助额外小剂量镇痛药物镇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.
【作者单位】：武汉市江夏区第一人民医院骨科;华中科技大学同济医学院附属普爱医院骨科;
【分类号】：R687.4

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