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重庆医科大学附属第一医院麻醉科
纸质出版日期:2017,
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熊秋菊, 刘小男, 何开华, 等. 连续腰丛神经阻滞联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价[J]. 重庆医科大学学报, 2017,42(5):560-564.
Xiong Qiuju, Liu Xiaonan, He Kaihua, et al. Efficacy of continuous lumbar plexus block combining with multimodal analgesia after revision hip arthroplasty[J]. Journal of Chongqing Medical University, 2017,42(5):560-564.
熊秋菊, 刘小男, 何开华, 等. 连续腰丛神经阻滞联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价[J]. 重庆医科大学学报, 2017,42(5):560-564. DOI: 10.13406/j.cnki.cyxb.001195.
Xiong Qiuju, Liu Xiaonan, He Kaihua, et al. Efficacy of continuous lumbar plexus block combining with multimodal analgesia after revision hip arthroplasty[J]. Journal of Chongqing Medical University, 2017,42(5):560-564. DOI: 10.13406/j.cnki.cyxb.001195.
目的:比较连续腰丛神经阻滞(continuous lumbar plexus block
CLPB)联合多模式镇痛与患者静脉自控镇痛(patient controlled intravenous analgesia
PCIA)联合多模式镇痛在髋关节翻修术术后镇痛中的效果评价。方法:68例单侧髋关节翻修的患者随机平均分成CLPB组与PCIA组。2组患者术前3 d使用帕瑞昔布钠镇痛;CLPB组术后经患侧腰丛神经周围置管处使用罗哌卡因镇痛
PCIA组术后经静脉使用曲马多加氟比洛芬酯镇痛
2组患者持续镇痛3 d
且术后加用帕瑞昔布钠镇痛直至运动时VAS评分<3分。记录患者术后在静息及运动状态下的视觉模拟疼痛评分(visual analogue scale
VAS)、静脉注射帕瑞昔布钠用量、镇痛泵按压次数及不良反应。结果:CLPB组患者术后各时刻点在静息状态及运动状态下的VAS评分明显低于PCIA组(P<0.05);CLPB组术后6、12、24 h在运动状态下的VAS评分分别为(2.50±0.71)、(3.59±0.99)、(3.67±1.01)分
明显低于对应时刻点的PCIA组:(4.97±0.94)分(P=0.00)、(4.85±0.86)分(P=0.00)、(4.32±0.73)分(P=0.00);镇痛泵按压次数及术后帕瑞昔布钠用量明显少于PCIA组(P<0.05);不良反应发生率低于PCIA组。结论:CLPB联合多模式镇痛能有效缓解髋关节翻修术术后的早期疼痛
其术后镇痛效果优于PCIA
不良反应发生低
是髋关节翻修术较为理想的镇痛方案。
Objective:To compare the analgesic efficacy between the continuous lumbar plexus block(CLPB) combining with multimodal analgesia and patient controlled intravenous analgesia(PCIA)combining with multimodal analgesia after revision hip arthroplasty. Methods:Totally 68 patients for single side revision hip arthroplasty were equally divided into CLPB group and PCIA group. The parecoxib was used in both groups 3 days before operation. The ropivacaine was used to analgesia through lumbar plexus catheteriza-tion in CLPB group
and the PCIA group with tramadol and flurbiprofen analgesia. All patients continued analgesia for 3 days. After operation
the parecoxib was used when visual analogue scale(VAS)scores more than 3 scores in exercise state. The VAS scores at rest and exercise state were estimated. The parecoxib dose by intravenous injection and the presses of the pump were recorded. And the complications were observed. Results:The VAS pain scores of CLPB group during rest at different time points after revision hip arthroplasty were significantly lower than those of PCIA group(P<0.05). The VAS scores of CLPB during exercise at 6 h
12 h
24 h after revision hip arthroplasty were(2.50±0.71)
(3.59±0.99)
(3.67±1.01)
which were significantly lower than those of(4.97±0.94)(P=0.00)
(4.85±0.86)(P=0.00)
(4.32±0.73)(P=0.00)in PCIA group at corresponding time points. In CLPB group
the parecoxib dose by intravenous injection and presses of the pump were fewer than that of PCIA group(P<0.05). And the side effects of CLPB group were fewer than those in PCIA group. Conclusion:CLPB combined with multimodal analgesia can alleviate the early pain of patients undergoing revision hip arthroplasty;the patients who received CLPB technique showed better pain relief
less complication than those who been given PCIA. Therefore
CLPB combined with multimodal analgesia should be considered a better analgesia method for patients after revision hip arthroplasty.
连续腰丛神经阻滞患者静脉自控镇痛多模式镇痛髋关节翻修术
continuous lumbar plexus blockpatient controlled intravenous analgesiamultimodal analgesiarevision hip arthro plasty
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