| 摘要: |
| 目的:观察羟考酮递减法背景输注在老年全髋人工关节置换术(THA)后镇痛中的应用效果。方法:选择2020 年4月—2023 年9 月在我院择期行THA 的患者90 例，男33 例，女57 例；ASA 分级I~Ⅱ级，年龄62~78 岁，体质量48耀78 kg。采用随机数字表法，将90 例患者分为3 组(n=30)，S 组术后静脉自控镇痛给予舒芬太尼2.0 滋g/kg +托烷司琼10 mg+0.9%生理盐水至100 mL，Q1 组和Q2 组术后静脉自控镇痛给予羟考酮0.20 mg/kg垣托烷司琼10 mg+0.9%生理盐水至100 mL。S 组和Q1 组患者镇痛参数均为背景输注速率2 mL/h，Q2 组患者镇痛参数第1 个12 h 为背景输注速率2 mL/h，之后每隔12 h 减20%，自控镇痛(PCA)量2 mL，锁定时间10 min。比较三组术毕(T1)、术后2 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)的VAS 评分，Ramsay镇静评分，术后48 h 内有效按压次数、药物使用总量，记录并比较三组的呼吸抑制、恶心、呕吐和皮肤瘙痒等不良反应。结果:S组T2-T4 时VAS 评分高于Q1 组和Q2 组(P<0.05)，S 组T2-T4 时Ramsay 镇静评分高于Q1 组和Q2 组(P<0.05)，Q1 组和Q2 组患者PCA 按压次数、药物总使用量均低于S 组(P<0.05)；Q2 组48 h 用药总量低于Q1 和S 组(P<0.05)；Q2 组术后恶心呕吐发生率低于S 组(P<0.05)。结论:老年患者行THA 术后应用羟考酮注射液递减法背景输注能获得满意的镇痛效果，减少了药物用量，并降低了不良反应发生率。 |
| 关键词: 羟考酮 老年 全髋人工关节置换 递减法 镇痛 |
| DOI：10.3969/j.issn.1007-6948.2024.05.019 |
| 投稿时间：2023-12-05 |
| 基金项目:中部战区总医院卫生战备专项课题(ZZ2021ZB08) |
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| Effect of oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty |
| HU Hui-ying,LI Shu-ting,LUO Zi-su |
| Anesthesiology Department of Central Theater Command General Hospital, Wuhan (430010), China |
| Abstract: |
| Objective To observe the effect of oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty. Methods Ninety patients undergoing total hip arthroplasty,from April 2020 to September 2023.33 males,57 females,aged 62~78 years,falling into ASA physical status I or Ⅱ, were randomly decided into the group Q1 (n=30), the group Q2 (n=30),and the group E(n=30). The patients in group S recieved sufentayl 2.0 ug/kg + tropisetron 10 mg + 0.9% normal saline to 100 mL.The patients in group Q1 and group Q2 received hydromorphone 0.20 mg/kg +tropisetron 10 mg+0.9% normal saline to 100 mL. The analgesic parameters of group S and group Q1 were background infusion rate of 2 mL/h, PCA amount of 2 mL, and lock-up time of 10 min. The analgesic parameters on the first 12 h after operation of group Q2 were background infusion rate of 2 mL/h, every 12 h later, the background infusion decreased by 20%, PCA amount of 2 mL, and lock-up time of 10 min. Recorded the VAS scores of the three groups the VAS scorses at 2 h,6 h,12 h and 24 h after surgery and the effective compression of PCIA , the amount of drug use within 48 hours points after surgery ,Ramsay sedation scores, and adverse reactions such as respiratory depression, nausea, vomiting, itching. Results The VAS score in group S T2-T4 were higher than those in group Q1 and group Q2 (P< 0.05). Ramsay sedation score in group S T2-T4 were lower than those in group Q1 and group Q2 (P< 0.05).The effective compression frequency and the volume of drug use of group Q1 and group Q2 within 48 hours were lower than that in group S (P< 0.05). The volume of drug use and postoperative nausea and vomiting in group Q2 were higher than that in group Q1 (P< 0.05). Conclusion Oxycodone successive subtraction method background infusion for postoperative analgesia in old patients undergoing total hip arthroplasty can obtain satisfactory analgesia effect, reduce the dosage of drugs and reduce the adverse reaction. |
| Key words: Oxycodone senil total hip arthroplasty successive subtraction method postoperative analgesia |
