[1]秦 悦,董补怀,赵元廷,等.多模式镇痛对老年颈后路手术患者血流动力学及术后早期疼痛效果研究[J].陕西医学杂志,2019,(10):1355-1359.
　QIN Yue,DONG Buhuai,Zhao Yuanting,et al.Effect of multimodal analgesia on hemodynamics and early postoperative 〖JZ〗pain in elderly patients with posterior cervical surgery[J].,2019,(10):1355-1359.
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多模式镇痛对老年颈后路手术患者血流动力学及术后早期疼痛效果研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年10期
页码:
1355-1359
栏目:
临床研究
出版日期:
2019-10-05

文章信息/Info

Title:
Effect of multimodal analgesia on hemodynamics and early postoperative 〖JZ〗pain in elderly patients with posterior cervical surgery
文章编号:
DOI:10.3969/j.issn.10007377.2019.10.031
作者:
秦 悦; 董补怀; 赵元廷; 韩晓锐△
西安交通大学附属红会医院（西安 710054）
Author(s):
QIN Yue; DONG Buhuai; Zhao Yuanting; et al.
Honghui Hospital,Xi’an Jiaotong University（Xi’an 710054）
关键词:
右美托咪定; 罗哌卡因; 多模式镇痛; 颈椎病; 老年人
Keywords:
Key words 〖WT5BZ〗〖HT5”SS〗Dexmedetomidine; Ropivacaine; Multimodal analgesia; Cervical spondylosis; Elderly
分类号:
R653
文献标志码:
A
摘要:
摘 要 目的：观察应用右美托咪定持续输注联合盐酸罗哌卡因伤口浸润对老年颈后路手术患者血流动力学及术后疼痛的临床效果。方法：接受颈后路椎板切除减压融合内固定术的128例老年颈椎病患者随机分为两组，试验组在麻醉诱导时输注0.5 μg/kg·h右美托咪定持续至术毕，同时以0.5%盐酸罗哌卡因20 ml行切口周围局部注射；对照组在麻醉诱导及术中不应用右美托咪定，术毕伤口周围注射20 ml 0.9%氯化钠生理盐水，每组64例；手术均采用全身麻醉，两组患者术后均接受静脉自控镇痛泵（PCA）治疗；记录患者入室时、麻醉后、切皮后30 min、缝合时、拔管后即刻、拔管后30 min、拔管后60 min各时间点平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）；记录术前、术后即刻、术后2 h、6 h、12 h、24 h、48 h患者疼痛视觉模拟(VAS)评分，评估术后早期镇痛效果；记录拔管后48 h补救使用镇痛药物剂量及舒芬太尼消耗量；统计术后相关并发症发生率。结果：两组患者在一般资料上差异无统计学意义(P＞0.05)，麻醉及手术均顺利完成。试验组与对照组患者入室时血压、心率、血氧饱和度无显著差异(P＞0.05)，试验组在麻醉后、切皮后30 min、缝合时、拔管后即刻、拔管后5 min时间点MAP明显低于对照组(P＜0.05)，而拔管后30 min、60 min两组之间无明显差异(P＞0.05)；试验组在麻醉后、切皮后30 min、缝合时、拔管后即刻、拔管后5 min、拔管后30 min 、拔管后60 min HR明显低于对照组(P＜0.05)，而各时间点SpO2比较无显著差别(P＞0.05)。两组患者术前疼痛VAS评分无统计学差异(P＞0.05)，而术后即刻、术后2h、6h、12 h、24 h、48 h各时间点试验组 VAS 评分显著低于对照组，差异有统计学意义(P＜0.05)。试验组患者术后补救使用镇痛药物的使用剂量明显少于对照组(P＜0.05) ，使用舒芬太尼剂量试验组也明显低于对照组，具有显著统计学差异(P＜0.05)。术后试验组并发症发生率明显低于对照组(P＜0.05)。结论：老年颈后路手术患者术中应用右美托咪定持续输注联合盐酸罗哌卡因伤口浸润可安全有效的维持血流动力学稳定，明显减轻患者术后早期疼痛，减少疼痛相关并发症的发生，促进患者功能恢复。
Abstract:
Abstract 〖WT5BZ〗〖HT5”SS〗Objective：To observe the clinical effect of continuous infusion of dexmedetomidine (Dex) combined with ropivacaine hydrochloride infiltration on hemodynamics and postoperative pain in elderly patients with posterior cervical surgery.Methods: 128 elderly patients with cervical spondylosis who underwent posterior cervical laminectomy and decompression and internal fixation were randomly divided into two groups.The experimental group was infused with 0.5 u g/kg/h dexmedetomidine for anesthesia induction until the end of the operation,and local injection was performed with 20 ml of 0.5% ropivacaine hydrochloride;Dex was not used in the control group during anesthesia induction and surgery,then 20 ml of 0.9% sodium chloride normal saline was injected around the wound.Both groups received postoperative intravenous analgesia pump (PCA) treatment.Mean arterial pressure (MAP),heart rate (HR),and oxygen saturation(SpO2) were recorded at the time of patient entry,after anesthesia,30 min after incision,suture,immediately after extubation,30 min after extubation,and 60 min after extubation.Pain visual analogue (VAS) scores were recorded before surgery,immediately after surgery,2 h,6 h,12 h,24 h,48 h 〖LM〗after surgery.The remedied analgesic dose and sufentanil consumption were recorded with 48 hours after extubation;the postoperative painrelated complications complications were counted.Results:There was no significant difference in the general data between the two groups (P＞0.05),and all the anesthesia and surgery were successfully completed.There was no significant difference in blood pressure,heart rate and blood oxygen saturation between the experimental group and the control group at the time of patient entry(P＞0.05).The MAP of the experimental group was significantly lower than that of the control group (P＜0.05) after anesthesia,30 min after incision,suture,immediately after extubation,and 5 min after extubation,but no significant difference between the two groups at 30 min and 60 min after extubation.Difference (P＞0.05);The HR of the experimental group was significantly lower than that of the control group after anesthesia,30 min after incision,suture,immediately after extubation,5 min after extubation,30 min after extubation,and 60 min after extubation (P＜0.05).There was no significant difference in SpO2 at each time point between two group(P＞0.05).There was no significant difference in preoperative pain VAS score between the two groups (P＞0.05),but the VAS scores of the test group were significantly lower than the control group at the time points immediately after surgery,2 h,6 h,12 h,24 h and 48 h after surgery (P＜0.05).The dose of postoperative remedial analgesic drugs and the sufentanil dose in the experimental group was significantly lower than that in the control group (P＜0.05).The incidence of complications in the postoperative group was significantly lower than that in the control group (P＜0.05).Conclusion: Intraoperative dexmedetomidine continuous infusion combined with ropivacaine hydrochloride wound infusion in elderly patients with posterior cervical surgery can safely and effectively maintain hemodynamic stability,significantly reduce early postoperative pain and reduce painrelated complications which can promote the recovery of patient function.

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更新日期/Last Update: 2019-10-23