CAJ | 학술논문

目的观察切口周围注射混合药物在腰椎后路手术围手术期多模式镇痛方案的镇痛效果.方法 64例腰椎后路手术患者随机分为研究组32例和对照组32例.研究组患者术前1d及术后第2天给予氨酚羟考酮片,每次1片,每天3次,服用4～7d,术后放置静脉自控镇痛泵,术中切口周围注射混合药物(罗哌卡因150 mg;氟比洛芬酯注射液50 mag;肾上腺素0.4ml,加无菌生理盐水至50 ml).对照组患者仅放置静脉自控镇痛泵.术前、术后分别记录静止与活动视觉模拟评分(VAS)、腰椎JOA评分评定临床症状改善情况,Prolo腰椎功能评分评定患者术后功能改善情况,并进行比较.结果 (1)VAS评分:研究组术后6、12、24 h、首次下地活动评分[(3.1±1.6)、(2.8±1.1)、(2.4±0.9)、(2.3±1.1)分]低于对照组[(3.5±1.8)、(3.4±1.3)、(3.4±0.8)、(3.0±1.5)分],差异均有统计学意义(P均＜0.05);两组出院时VAS评分比较差异无统计学意义(P＞0.05).(2)腰椎JOA评分:研究组术后第1、3、7天JOA评分高于对照组(P均＜0.05),两组出院时差异无统计学意义.(3) Prolo腰椎功能评分:研究组术后第1、3、7天Prolo腰椎功能评分高于对照组(P均＜0.05),两组出院时差异无统计学意义.结论腰椎后路手术术中切口周围注射复合药物在多模式镇痛方案中可以起到一定效果,术后临床症状和腰椎功能改善满意.
목적 관찰절구주위주사혼합약물재요추후로수술위수술기다모식진통방안적진통효과.방법 64례요추후로수술환자수궤분위연구조32례화대조조32례.연구조환자술전1d급술후제2천급여안분간고동편,매차1편,매천3차,복용4～7d,술후방치정맥자공진통빙,술중절구주위주사혼합약물(라고잡인150 mg;불비락분지주사액50 mag;신상선소0.4ml,가무균생리염수지50 ml).대조조환자부방치정맥자공진통빙.술전、술후분별기록정지여활동시각모의평분(VAS)、요추JOA평분평정림상증상개선정황,Prolo요추공능평분평정환자술후공능개선정황,병진행비교.결과 (1)VAS평분:연구조술후6、12、24 h、수차하지활동평분[(3.1±1.6)、(2.8±1.1)、(2.4±0.9)、(2.3±1.1)분]저우대조조[(3.5±1.8)、(3.4±1.3)、(3.4±0.8)、(3.0±1.5)분],차이균유통계학의의(P균＜0.05);량조출원시VAS평분비교차이무통계학의의(P＞0.05).(2)요추JOA평분:연구조술후제1、3、7천JOA평분고우대조조(P균＜0.05),량조출원시차이무통계학의의.(3) Prolo요추공능평분:연구조술후제1、3、7천Prolo요추공능평분고우대조조(P균＜0.05),량조출원시차이무통계학의의.결론 요추후로수술술중절구주위주사복합약물재다모식진통방안중가이기도일정효과,술후림상증상화요추공능개선만의.
Objective To evaluate the efficiency of multimodal analgesia for the patients who had the posterior lumbar spine surgery.Methods Sixty-four cases of patients who were scheduled to the posterior lumbar spine surgery were randomly divided into two groups, multimodal analgesia group (n =32) and control group(n=32).Multimodal analgesia group patients were given oxycodone acetaminophen 1 day before and the next day after operation, during the operation the patients received injiection of multimodal drugs (consisting of ropivacaine 150 mg, flurbiprofen 50 mg, phenylephrine 0.4 ml, normal saline 50 ml) around the incisions by infiltrated injection before the skin incision closed, then had controlled intravenous analgesia.In the control group, the incisions were sutured without the local infiltration analgesia.Then only had patient controlled intravenous analgesia after operati on.Visual analogue scale(VAS) ,Japanese Orthopedic Association(JOA) and Prolo lumbar function score was recorded respectively perioperatively.Results (1) VAS: the patients of multimodal analgesia group had significantly lower rest pain scores and activity pain scores at 6, 12,24 hours, first moving than the control group((3.1±1.6) ,(2.8±1.1),(2.4±0.9) ,(2.3±1.1) vs.(3.5±1.8) ,(3.4± 1.3), (3.4±0.8), (3.0± 1.5), P＜0.05).There was no significant difference at the discharge between the two groups (P＞0.05).(2)JOA:JOA scores of the patients of multimodal analgesia group were obviously higher than that of the control group at 1,3,7 days after operation (P＜0.05).There was no significant difference at the discharge between the two groups (P＞0.05).(3) Prolo lumbar function score : Prolo scores of the patients of the multimodal analgesia group were obviously higher than that of control group at 1,3,7 days after operation (P ＜0.05).There was no significant difference at the discharge between the two groups(P＞0.05).Conclusion Multimodal Analgesia is shown to safely provide excellent pain control and functional recovery.It can reduce visual analogue pain score and improve lumbar function after surgery.