CAJ | 학술논문

目的评价连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛的效果.方法择期拟行髋关节置换术病人60例,性别不限,年龄51 ～ 75岁,体重47 ～ 77 kg,身高150～181 cm,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其随机分为术后病人自控静脉镇痛组(PCIA组)和连续腰丛神经阻滞联合夜间单次加强术后镇痛组(CLPB组),每组30例.所有病人行腰麻,手术结束前30 min,PCIA组病人上臂头静脉接病人自控静脉镇痛泵,药物配方:吗啡100mg+生理盐水稀释至100 ml,参数:首剂量0,持续量0,单次追加量2 mg,锁定时间5 min；CLPB组病人腰丛给予0.125％罗哌卡因30 ml后接镇痛泵,药物配方为0.125％盐酸罗哌卡因,持续量8 ml/h,单次追加量4 ml,锁定时间30 min,术后每晚8时追加0.25％罗哌卡因30 ml.记录术后6、12、18、24、30、36、42和48 h时病人静息及活动时VAS评分,观察恶心呕吐、瘙痒和尿潴留等不良反应的发生情况,随访总体满意情况,记录夜间由于疼痛导致睡眠中断次数和髋关节最大屈曲和外展活动度.结果与PCIA组比较,CLPB组病人运动时VAS评分、术后恶心呕吐、瘙痒、尿潴留严重程度和夜间由于疼痛导致睡眠中断次数降低,病人总体满意度、髋关节最大屈曲和外展活动度升高(P＜0.05).结论与术后病人自控静脉镇痛相比,连续腰丛神经阻滞联合夜间单次加强用于病人髋关节置换术后镇痛效果好,且并发症少.
목적 평개련속요총신경조체연합야간단차가강용우병인관관절치환술후진통적효과.방법 택기의행관관절치환술병인60례,성별불한,년령51 ～ 75세,체중47 ～ 77 kg,신고150～181 cm,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장기수궤분위술후병인자공정맥진통조(PCIA조)화련속요총신경조체연합야간단차가강술후진통조(CLPB조),매조30례.소유병인행요마,수술결속전30 min,PCIA조병인상비두정맥접병인자공정맥진통빙,약물배방:마배100mg+생리염수희석지100 ml,삼수:수제량0,지속량0,단차추가량2 mg,쇄정시간5 min；CLPB조병인요총급여0.125％라고잡인30 ml후접진통빙,약물배방위0.125％염산라고잡인,지속량8 ml/h,단차추가량4 ml,쇄정시간30 min,술후매만8시추가0.25％라고잡인30 ml.기록술후6、12、18、24、30、36、42화48 h시병인정식급활동시VAS평분,관찰악심구토、소양화뇨저류등불량반응적발생정황,수방총체만의정황,기록야간유우동통도치수면중단차수화관관절최대굴곡화외전활동도.결과 여PCIA조비교,CLPB조병인운동시VAS평분、술후악심구토、소양、뇨저류엄중정도화야간유우동통도치수면중단차수강저,병인총체만의도、관관절최대굴곡화외전활동도승고(P＜0.05).결론 여술후병인자공정맥진통상비,련속요총신경조체연합야간단차가강용우병인관관절치환술후진통효과호,차병발증소.
Objective To evaluate the efficacy of continuous lumbar plexus block (CLPB) combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 51-75 yr,weighing 47-77 kg,with body height 150-180 cm,scheduled for hip arthroplasty,were randomized to receive either CLPB (group CLPB) or patient-controlled intravenous analgesia (PCIA) (PCIA group) for postoperative analgesia (n =30 each).Spinal anesthesia was performed at L3,4 interspace.Postoperative analgesia was performed at 30 min before the end of surgery.PCIA solution contained morphine 100 mg in 100 ml of normal saline.The PCA pump was set up with a 2 mg bolus dose and a 5 min lockout interval.CLPB solution contained 0.125 ％ ropivacaine hydrochloride 200 ml.CLPB pump was set up to deliver a 4 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h after a loading dose of 0.125％ ropivacaine 30 ml.In addition the patients received 0.25％ ropivacaine 30 ml at 8 o' clock every night after surgery in group CLPB.VAS scores at rest and during activity were recorded at 6,12,18,24,30,36,42 and 48h after operation.The side effect such as nausea and vomiting,pruritus and urinary retention were recorded within 48 h after operation.The patient' s satisfaction was assessed.The maximal hip flexion and abduction ranges of motion were recorded at 12,24,36 and 48 h after operation.The times of sleep interruption resulted from pain during nighttime were also recorded.Results Compared with group PCIA,the VAS scores during activity,severity of nausea and vomiting,pruritus and urinary retention,and times of sleep interruption resulted from pain during nighttime were significantly decreased,and the overall satisfaction score and maximal hip flexion and abduction ranges of motion were increased in group CLPB (P ＜ 0.05).Conclusion CLPB combined with a bolus dose added at night can provide better efficacy for postoperative analgesia in patients undergoing hip arthroplasty than PCIA,with fewer complications.