摘要
目的探讨超声引导下髂筋膜阻滞联合静脉注射帕瑞昔布钠在老年髋部骨折患者加速康复中的应用价值。方法本研究为单中心随机对照试验,收集河北大学附属医院骨一病区2021年5月至12月行手术治疗的老年单侧髋部骨折患者64例,随机分为多模式镇痛组(MMA组,33例)和药物镇痛组(31例)。评估并比较两组患者入院、术晨、术后4 h、24 h、1周时疼痛数字评分量表(NRS)评分以及行补救镇痛治疗患者例数;评估入院、术后1周时医院焦虑抑郁量表(HADS)评分以及焦虑、抑郁症状发生率;检测术前和术后1 d时患者血清IL-6、IL-1β、CRP、Cor浓度(均采用酶联免疫吸附实验);记录镇痛不良反应发生情况、围术期并发症以及住院时间。结果两组患者性别、年龄、骨折部位等一般资料比较差异均无统计学意义(P均>0.05)。与药物镇痛组比较,术晨、术后4 h的MMA组患者NRS评分均低于药物镇痛组(P<0.001)。MMA组行补救镇痛治疗患者1例,少于药物镇痛组7例(P<0.05)。术后1周时两组患者入院HADS评分及焦虑、抑郁症状发生率均较术前显著降低(P均<0.05),且MMA组术后1周的抑郁评分、抑郁症状发生率显著低于药物镇痛组(P<0.05)。与治疗前比较,术后1 d两组患者血清IL-6、IL-1β、CRP及Cor浓度均增高,差异有统计学意义(P<0.05)。与药物镇痛组比较,MMA组术后1 d时各观察指标均较低,差异有统计学意义(P<0.05)。恶心呕吐发生率MMA组患者显著低于药物镇痛组,差异有统计学意义(P<0.05)。结论超声引导下髂筋膜阻滞联合静脉注射帕瑞昔布钠的多模式镇痛可显著改善老年髋部骨折患者围术期疼痛程度,缓解患者抑郁情绪,有效减轻术后应激反应,降低机体炎性反应水平,同时可能降低术后恶心呕吐等镇痛不良反应的发生率且不增加围术期发生并发症的风险。
Objective To evaluate ultrasound-guided fascial iliac block with parecoxib sodium in accelerated rehabilitation of hip fractures in the elderly.Methods A total of 64 elderly patients with unilateral hip fracture who underwent surgical treatment,from May to December 2021 in the Bone First Ward,Affiliated Hospital of Hebei University,were randomly divided into the MMA group(n=33)and the medication analgesia group(n=31).The NRS at admission,early morning,4 h,24 h,and 1 week after surgery were recorded and the number of patients received salvage analgesia treatment were compared.Hospital anxiety and depression scale(HADS)at admission and one week after surgery were assessed and the incidence of anxiety and depression symptoms were compared.Changes of serum IL-6,IL-1β,CRP and Cor concentrations were recorded before and 1 day after surgery.The adverse reactions,perioperative complications,and hospital stay were also recorded.Results Compared with the medication analgesia group,the NRS was lower in the morning and 4 h after surgery in MMA group(P<0.001).One patient in the MMA group and seven patients in the medication analgesia group received remedial analgesia treatment(P<0.05).HADS and the incidence of anxiety and depression symptoms were significantly lower than before surgery(P<0.05)in both groups of patients,and the depression score and the incidence of depressive symptoms were significantly lower in the MMA group than those in the medication analgesia group(P<0.05).The serum levels of IL-6,IL-1βand the concentrations of CRP and Cor were increased at 1 day after surgery in both groups(P<0.05)and were significantly lower in the MMA group than those in the medication analgesia group at 1 day after surgery(P<0.05).The incidence of cardiac vomiting was significantly lower in the MMA group than that in the medication analgesia group(P<0.05).Conclusion Multimodal analgesia with ultrasound-guided fascial iliac block combined with intravenous paecoxib sodium improves perioperative pain,relieves patients'depression,effectively reduces postoperative stress response,reduces the level of inflammatory response in the body,elderly patients with hip fractures without increasing the risk of perioperative complications.
作者
钱蓉
牛亚楠
潘炫屹
陈恒利
杨美丽
王红杰
Qian Rong;Niu Yanan;Pan Xuanyi;Chen Hengli;Yang Meili;Wang Hongjie(Department of Anesthesiology,The Affiliated Hospital of Hebei University/Clinical Medical Sciences,Baoding City,Hebei Province 071000,China;Department of Orthopedics,The Affiliated Hospital of Hebei University/Clinical Medical Sciences,Baoding City,Hebei Province 071000,China;Baoding Institute for Food and Drug Control,Baoding City,Hebei Province 071000,China)
出处
《中华疼痛学杂志》
2023年第6期962-968,共7页
Chinese Journal Of Painology
基金
2018年河北省财政厅、卫健委资助项目(361007)。
关键词
老年人
髋骨折
镇痛
围手术期医护
加速康复外科
Aged
Hip fracture
Analgesia
Perioperative care
Enhanced recovery after surgery
