CAJ | 학술논문

背景：全髋关节置换后的剧烈疼痛是影响患者术后关节功能恢复最重要的因素之一，如何做到置换后良好的镇痛是目前研究的热点问题。目的：探讨不同浓度罗哌卡因用于全髋关节置换后的镇痛效果。方法：选取2012年1月至2014年6月于宿迁市人民医院骨外科行全髋关节置换的患者69例，ASA分级Ⅰ-Ⅲ级，采用随机数字表法分为0.25%罗哌卡因组、0.3%罗哌卡因组、0.35%罗哌卡因组，每组23例。置换结束后30 min，行罗哌卡因连续髂筋膜腔隙阻滞，开始各组注入相应浓度的罗哌卡因20 mL，随后接镇痛泵，无背景剂量，自控镇痛剂量为10 mL，时间60 min，持续72 h。于阻滞12，24，48和72 h时记录静息、被动运动和主动运动目测类比评分，静息目测类比评分≥4分时，静脉注射帕瑞昔布钠40 mg。记录阻滞后72 h内罗哌卡因用量、帕瑞昔布钠使用情况、离床时间及不良反应发生情况，同时评价患者镇静情况。结果与结论：与0.25%罗哌卡因组患者比较，0.3%罗哌卡因组和0.35%罗哌卡因组患者静态时目测类比评分差异无显著性意义(P>0.05)，被动运动和主动运动目测类比评分均降低(P<0.05)，阻滞后72 h内罗哌卡因用量降低；与0.3%罗哌卡因组比较，0.35%罗哌卡因组静态时、被动运动和主动运动目测类比评分比较差异均无显著性意义(P >0.05)；0.3%罗哌卡因组和0.35%罗哌卡因组罗哌卡因用量比较差异无显著性意义(P >0.05)。0.3%罗哌卡因组和0.35%罗哌卡因组帕瑞昔布钠使用率显著低于0.25%罗哌卡因组(P<0.05)，离床时间短于0.25%罗哌卡因组。并发症发生情况在3组间差异无显著性意义(P>0.05)。提示3组不同浓度的哌罗卡因对全髋关节置换后患者均有一定的镇痛作用，且不良反应较少，其中0.3%的罗哌卡因是全髋关节置换后镇痛的适宜浓度，可减少哌罗卡因的使用量，并缩短患者离床时间。揹景：全髖關節置換後的劇烈疼痛是影響患者術後關節功能恢複最重要的因素之一，如何做到置換後良好的鎮痛是目前研究的熱點問題。目的：探討不同濃度囉哌卡因用于全髖關節置換後的鎮痛效果。方法：選取2012年1月至2014年6月于宿遷市人民醫院骨外科行全髖關節置換的患者69例，ASA分級Ⅰ-Ⅲ級，採用隨機數字錶法分為0.25%囉哌卡因組、0.3%囉哌卡因組、0.35%囉哌卡因組，每組23例。置換結束後30 min，行囉哌卡因連續髂觔膜腔隙阻滯，開始各組註入相應濃度的囉哌卡因20 mL，隨後接鎮痛泵，無揹景劑量，自控鎮痛劑量為10 mL，時間60 min，持續72 h。于阻滯12，24，48和72 h時記錄靜息、被動運動和主動運動目測類比評分，靜息目測類比評分≥4分時，靜脈註射帕瑞昔佈鈉40 mg。記錄阻滯後72 h內囉哌卡因用量、帕瑞昔佈鈉使用情況、離床時間及不良反應髮生情況，同時評價患者鎮靜情況。結果與結論：與0.25%囉哌卡因組患者比較，0.3%囉哌卡因組和0.35%囉哌卡因組患者靜態時目測類比評分差異無顯著性意義(P>0.05)，被動運動和主動運動目測類比評分均降低(P<0.05)，阻滯後72 h內囉哌卡因用量降低；與0.3%囉哌卡因組比較，0.35%囉哌卡因組靜態時、被動運動和主動運動目測類比評分比較差異均無顯著性意義(P >0.05)；0.3%囉哌卡因組和0.35%囉哌卡因組囉哌卡因用量比較差異無顯著性意義(P >0.05)。0.3%囉哌卡因組和0.35%囉哌卡因組帕瑞昔佈鈉使用率顯著低于0.25%囉哌卡因組(P<0.05)，離床時間短于0.25%囉哌卡因組。併髮癥髮生情況在3組間差異無顯著性意義(P>0.05)。提示3組不同濃度的哌囉卡因對全髖關節置換後患者均有一定的鎮痛作用，且不良反應較少，其中0.3%的囉哌卡因是全髖關節置換後鎮痛的適宜濃度，可減少哌囉卡因的使用量，併縮短患者離床時間。
배경：전관관절치환후적극렬동통시영향환자술후관절공능회복최중요적인소지일，여하주도치환후량호적진통시목전연구적열점문제。목적：탐토불동농도라고잡인용우전관관절치환후적진통효과。방법：선취2012년1월지2014년6월우숙천시인민의원골외과행전관관절치환적환자69례，ASA분급Ⅰ-Ⅲ급，채용수궤수자표법분위0.25%라고잡인조、0.3%라고잡인조、0.35%라고잡인조，매조23례。치환결속후30 min，행라고잡인련속가근막강극조체，개시각조주입상응농도적라고잡인20 mL，수후접진통빙，무배경제량，자공진통제량위10 mL，시간60 min，지속72 h。우조체12，24，48화72 h시기록정식、피동운동화주동운동목측류비평분，정식목측류비평분≥4분시，정맥주사파서석포납40 mg。기록조체후72 h내라고잡인용량、파서석포납사용정황、리상시간급불량반응발생정황，동시평개환자진정정황。결과여결론：여0.25%라고잡인조환자비교，0.3%라고잡인조화0.35%라고잡인조환자정태시목측류비평분차이무현저성의의(P>0.05)，피동운동화주동운동목측류비평분균강저(P<0.05)，조체후72 h내라고잡인용량강저；여0.3%라고잡인조비교，0.35%라고잡인조정태시、피동운동화주동운동목측류비평분비교차이균무현저성의의(P >0.05)；0.3%라고잡인조화0.35%라고잡인조라고잡인용량비교차이무현저성의의(P >0.05)。0.3%라고잡인조화0.35%라고잡인조파서석포납사용솔현저저우0.25%라고잡인조(P<0.05)，리상시간단우0.25%라고잡인조。병발증발생정황재3조간차이무현저성의의(P>0.05)。제시3조불동농도적고라잡인대전관관절치환후환자균유일정적진통작용，차불량반응교소，기중0.3%적라고잡인시전관관절치환후진통적괄의농도，가감소고라잡인적사용량，병축단환자리상시간。
BACKGROUND:Severe pain after total hip arthroplasty is an important factor for successful rehabilitation of postoperative joint function. Analgesic method after total hip arthroplasty is a hot issue. OBJECTIVE:To investigate the analgesic effect of different concentrations of ropivacaine after total hip arthroplasty. METHODS:69 patients undergoing total hip arthroplasty were recruited from Department of Anesthesiology, Suqian People’s Hospital, from January 2012 to June 2014. According to the ASA classification, their physical status was graded I to III. The involved patients were randomly divided into three groups:0.25%ropivacaine group, 0.3%ropivacaine group, 0.35%ropivacaine group. Each group had 23 cases. At 30 minutes after the surgery, different concentrations of ropivacaine, 20 mL, were injected to patients due to continuous fascia iliaca compartment block. The catheter was then connected to a patient-control ed analgesia pump programmed to deliver 10 mL with a lockout interval of 60 minutes, for postoperative analgesia (72 hours). At 12, 24, 48 and 72 hours of blockade, the visual analogous scale (VAS) scores at rest, passive and active activity were recorded. When VAS score at rest ≥ 4 points, parecoxib sodium 40 mg was injected intravenously. The consumption of ropivacaine within 72 hours after the blockade, application of parecoxib sodium, time of ambulation, and adverse reactions during blockade were recorded. The analgesic effect in the three groups was also observed. RESULTS AND CONCLUSION:Compared with 0.25%ropivacaine group, static VAS scores of 0.3%ropivacaine group and 0.35%ropivacaine group showed no significant difference (P>0.05), passive and active VAS scores were significantly decreased (P<0.05), and the consumption of ropivacaine within 72 hours after the blockade was significantly decreased. There was no significant difference in the rest, passive and active VAS scores between 0.3%ropivacaine group and 0.35%ropivacaine group (P>0.05). The ropivacaine consumption of 0.3%ropivacaine group and 0.35%ropivacaine group was not statistical y significant (P>0.05). The usage of parecoxib sodium in 0.3%ropivacaine group and 0.35%ropivacaine group was significantly lower than that in 0.25%ropivacaine group (P<0.05). Day of first walk was earlier in the 0.3%ropivacaine group and 0.35%ropivacaine group. The incidence of complications among the three groups showed no significant difference (P>0.05). Experimental findings indicate that, three different concentrations of ropivacaine has certain analgesic effects after total hip arthroplasty with fewer adverse reactions, and the concentration of 0.3%ropivacaine is the suitable concentration for postoperative analgesia of total hip arthroplasty, it can reduce the amount of parecoxib sodium and shorten the day of first walk.