CAJ | 학술논문

目的探讨多模式镇痛对老年髋部骨折术后谵妄发生情况的影响.方法 2010年10月至2012年7月,前瞻性研究65岁以上髋部手术患者108例,按术后镇痛模式将患者分为多模式镇痛组和传统镇痛组.多模式镇痛组59例,男25例,女34例；年龄65～86岁,平均(72.91±5.42)岁；行全髋关节置换术35例,行股骨转子间骨折内固定术24例.传统镇痛组49例,男22例,女27例；年龄65～84岁,平均(72.14±4.93)岁；行全髋关节置换术29例,行股骨转子间骨折内固定术20例.根据美国精神疾病协会制定的意识错乱评估方法对患者精神状况进行评估.多模式镇痛组术中实施切口周围浸润阻滞,术后给予静脉镇痛泵,并常规静脉滴注非甾体类镇痛药3d.传统镇痛组在术后疼痛时给予同一常规剂量阿片类药物强化镇痛.对于发生术后谵妄的患者,两组均给予强化镇痛干预.结果多模式镇痛组术后疼痛视觉模拟评分(visual analogue scale,VAS)静息及活动时分别为:第1天时(2.10±1.43)分、(4.74±1.45)分,第3天时(1.01±0.92)分、(3.31±1.36)分；传统镇痛组VAS分别为:第1天时(4.67±1.33)分、(7.44±1.59)分,3天时(2.24±1.39)分、(5.06±1.46)分.无论是静息还是活动状态,两组VAS评分比较差异均有统计学意义.术后3d内,传统镇痛组15例(30.6％,15/49)、多模式镇痛组7例(11.9％,7/59)发生谵妄.对发生谵妄的22例患者,肌内一次注射10 mg吗啡后,均有至少一项以上不良反应缓解.结论应用多模式镇痛手段可减少术后谵妄发生,对已发生术后谵妄患者,强化镇痛可进一步缓解病情.
목적 탐토다모식진통대노년관부골절술후섬망발생정황적영향.방법 2010년10월지2012년7월,전첨성연구65세이상관부수술환자108례,안술후진통모식장환자분위다모식진통조화전통진통조.다모식진통조59례,남25례,녀34례；년령65～86세,평균(72.91±5.42)세；행전관관절치환술35례,행고골전자간골절내고정술24례.전통진통조49례,남22례,녀27례；년령65～84세,평균(72.14±4.93)세；행전관관절치환술29례,행고골전자간골절내고정술20례.근거미국정신질병협회제정적의식착란평고방법대환자정신상황진행평고.다모식진통조술중실시절구주위침윤조체,술후급여정맥진통빙,병상규정맥적주비치체류진통약3d.전통진통조재술후동통시급여동일상규제량아편류약물강화진통.대우발생술후섬망적환자,량조균급여강화진통간예.결과 다모식진통조술후동통시각모의평분(visual analogue scale,VAS)정식급활동시분별위:제1천시(2.10±1.43)분、(4.74±1.45)분,제3천시(1.01±0.92)분、(3.31±1.36)분；전통진통조VAS분별위:제1천시(4.67±1.33)분、(7.44±1.59)분,3천시(2.24±1.39)분、(5.06±1.46)분.무론시정식환시활동상태,량조VAS평분비교차이균유통계학의의.술후3d내,전통진통조15례(30.6％,15/49)、다모식진통조7례(11.9％,7/59)발생섬망.대발생섬망적22례환자,기내일차주사10 mg마배후,균유지소일항이상불량반응완해.결론 응용다모식진통수단가감소술후섬망발생,대이발생술후섬망환자,강화진통가진일보완해병정.
Objective To study effects of multimodal analgesia on postoperative delirium (POD)in elder patients with hip fracture.Methods One hundred and eight elder patients with hip fractures were gathered in a prospective study.Fifty-nine cases were included in the group of multimodal analgesia (25 males,34 females),with an average age of 72.91±5.42 years,and 35 were treated with hip replacements,the other 24 were internal fixations.Forty-nine cases were in the group of conventional analgesia (22 males,27 females),with an average age of 72.14±4.93 years,29 were treated with hip replacements,20 were internal fixations.Assessments of delirium were based on confusion assessment method.Local infiltrated anesthesia,patient control intravenous analgesia,and intravenous nonsteroid anti-inflammatory drug were applied in the group of multimodal analgesia.For the other group,morphine would be given only when patient complained pain or there was POD.Postoperatively,visual analogue scale (VAS),onset of delirium,other correlative data were recorded by an independent researcher.All patients underwent POD were managed with intensive pain management,and then reevaluated.Results VAS in multimodal analgesia group [Day1:2.10±1.43(resting),4.74±1.45 (active) and Day 3:1.01±0.92 (resting),3.31±1.36 (active)] were significandy lower than that in the other group [Day1:4.67±1.33 (resting),7.44±1.59 (active)and Day 3:2.24±1.39 (resting),5.06±1.46 (active)].PODs were detected in 15 (30.6％) in group of conventional analgesia; while in group of multimodal analgesia,there were 7 (11.9％).All POD were given intensive pain managements by injection of 10 mg morphine and achieved relief of deliriums.Conclusion Postoperative multimodal analgesia may reduce the incidence of POD.First aid of intensive pain management may help to control POD.