CAJ | 학술논문

目的：观察下肢游离皮瓣移植术患者术前应用塞来昔布，联合术后使用自控静脉镇痛的镇痛效果，总结护理经验。方法选择2011年7月-2013年6月在本院创伤骨科择期行下肢游离皮瓣移植术的患者120例，按手术时间随机分为单次给药组、双次给药组和常规给药组，每组40例。单次给药组在常规术后镇痛的基础上于术前2 h口服塞来昔布400 mg；双次给药组在单次给药组的基础上，术前24 h增加口服塞来昔布400 mg 1次；常规给药组不进行超前给药，只使用常规术后镇痛方法。结果3组患者术后各时点芬太尼使用总量以及镇痛药物不良反应发生率差异均无统计学意义（P＞0.05）。单次给药组和双次给药组术后8 h开始疼痛评分显著低于对照组（P＜0．05）。单次给药组和双次给药组患者满意度显著高于对照组（P＜0．05）。结论下肢游离皮瓣移植术患者术前应用塞来昔布，联合术后使用自控静脉镇痛的镇痛效果明显优于常规镇痛，能显著提高患者的舒适度及满意度。由于单次给药组和双次给药组在疼痛评分、药物不良反应发生率方面无统计学差异，而单次给药组在给药次数及减少患者医疗费用方面有其优势，笔者建议临床使用单次给药的方式。
목적：관찰하지유리피판이식술환자술전응용새래석포，연합술후사용자공정맥진통적진통효과，총결호리경험。방법선택2011년7월-2013년6월재본원창상골과택기행하지유리피판이식술적환자120례，안수술시간수궤분위단차급약조、쌍차급약조화상규급약조，매조40례。단차급약조재상규술후진통적기출상우술전2 h구복새래석포400 mg；쌍차급약조재단차급약조적기출상，술전24 h증가구복새래석포400 mg 1차；상규급약조불진행초전급약，지사용상규술후진통방법。결과3조환자술후각시점분태니사용총량이급진통약물불량반응발생솔차이균무통계학의의（P＞0.05）。단차급약조화쌍차급약조술후8 h개시동통평분현저저우대조조（P＜0．05）。단차급약조화쌍차급약조환자만의도현저고우대조조（P＜0．05）。결론하지유리피판이식술환자술전응용새래석포，연합술후사용자공정맥진통적진통효과명현우우상규진통，능현저제고환자적서괄도급만의도。유우단차급약조화쌍차급약조재동통평분、약물불량반응발생솔방면무통계학차이，이단차급약조재급약차수급감소환자의료비용방면유기우세，필자건의림상사용단차급약적방식。
Objective To observe the effect of multi-mode preemptive analgesia on patients undergoing free lower limb skin flap transplantation and to summarize its nursing experience. Methods Totally 120 patients treated with free lower limb skin flap transplantation from July 2011 and June 2011 were randomized into the multi-mode preemptive analgesia groups (including single-dose group and double-dose group) and control group according to the time of operation, 40 patients in each group. These groups were treated with preemptive analgesia and routine analgesia respectively. Results The three groups showed no significant difference in total dosage of Fentanyl and adverse reactions caused by analgesics ( P>0.05). The postoperative VAS pain rating scale of the multi-mode preemptive analgesia groups were significantly lower than that of control group ( P<0.05). The satisfaction of the multi-mode preemptive analgesia groups were significantly higher than that of control group ( P<0.05). Conclusion The multi-mode preemptive analgesia with Celecoxib combined with patient-controlled analgesia (PCA) in patients treated with free lower limb skin flap transplantation is significantly superior to the routine analgesia effect. Moreover, the multi-mode preemptive analgesia can enhance patients’ satisfaction.