| 摘要: |
| ［摘要］ 目的 观察多模式镇痛在下肢骨折术后患者中的临床应用效果。方法 选择2020年1月至2020年12月于广西骨伤医院择期行下肢骨折手术的患者60例，采用随机数字表法分为M组和I组，每组30例。M组采用多模式镇痛［腘窝坐骨神经阻滞、收肌管阻滞联合患者自控静脉镇痛（PCIA）泵］；I组仅采用PCIA泵进行术后镇痛。比较两组术后6 h（T1）、12 h（T2）、24 h（T3）、48 h（T4）静卧及活动时的疼痛数字量表（NRS）评分、Ramsay镇静评分、徒手肌力检查（MMT）分级。比较两组术后并发症发生率、补救镇痛率以及镇痛满意度。结果 在T1～T4时间点，M组NRS评分呈上升趋势，而I组呈下降趋势。在T1～T3时间点，M组的NRS评分均较I组低，差异有统计学意义（P<0.05）。在T1～T4时间点，两组Ramsay镇静评分呈下降趋势，而MMT分级呈上升趋势，两组变化趋势比较差异无统计学意义（P>0.05）。I组术后发生头晕、头痛4例，恶心、呕吐3例；M组未观察到术后并发症的发生，两组术后并发症发生率比较差异有统计学意义（23.33% vs 0.00%； χ2=5.822，P=0.016）。M组和I组补救镇痛率比较差异无统计学意义（0.00% vs 10.00%； χ2=1.404，P=0.236）。M组镇痛满意度较I组好（Z=5.054，P=0.000）。结论 腘窝坐骨神经阻滞、收肌管阻滞联合PCIA泵的多模式镇痛在下肢骨折术后患者中的镇痛效果好，不良反应少，有利于提高患者对术后镇痛治疗的满意度。 |
| 关键词: 下肢骨折 多模式镇痛 收肌管阻滞 腘窝坐骨神经阻滞 |
| DOI：10.3969/j.issn.1674-3806.2022.03.12 |
| 分类号:R 614.4 |
| 基金项目:广西卫生健康委科研项目（编号：Z20190514） |
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| Observation on the clinical application effect of multimodal analgesia on patients with lower limb fractures after surgery |
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CHEN Xi, WU Bin
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Department of Operation and Anaesthesia, Guangxi Orthopedic Hospital, Nanning 530012, China
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| Abstract: |
| ［Abstract］ Objective To observe the clinical application effect of multimodal analgesia on patients with lower limb fractures after surgery. Methods Sixty patients who underwent elective surgery for lower limb fractures from January 2020 to December 2020 in Guangxi Orthopedic Hospital were selected and divided into M group and I group by random number table method, with 30 cases in each group. Multimodal analgesia was used in the M group［(popliteal sciatic nerve block, adductor canal block combined with patient controlled intravenous analgesia(PCIA) pump)］. However, only PCIA pump was used for postoperative analgesia in the I group. The Numeric Rating Scale(NRS) scores, Ramsay sedation scores, and manual muscle testing(MMT) grades were compared between the two groups in repose and activity 6 hours(T1), 12 hours(T2), 24 hours(T3) and 48 hours(T4) after operation. The incidence of postoperative complications, salvage analgesia rate and satisfaction with analgesia treatment were compared between the two groups. Results At T1-T4 time points, the NRS scores showed an upward trend in the M group and a downward trend in the I group. At T1-T3 time points, the NRS scores of the M group were lower than those of the I group, and the differences were statistically significant(P<0.05 ). At T1-T4 time points, the Ramsay sedation scores showed a downward trend in the two groups, while the MMT grades showed an upward trend in the two groups, and there were no statistically significant differences in the changing trends between the two groups(P>0.05). There were 4 cases of dizziness and headache, 3 cases of nausea and vomiting in the I group, and no postoperative complications were observed in the M group. There was a statistically significant difference in the rate of postoperative complications between the two groups(23.33% vs 0.00%; χ2=5.822, P=0.016). There was no significant difference in the salvage analgesia rate between the M group and the I group(0.00% vs 10.00%; χ2=1.404, P=0.236). The satisfaction with analgesia treatment in the M group was better than that in the I group(Z=5.054, P=0.000). Conclusion The multimodal analgesia of popliteal sciatic nerve block, adductor canal block combined with PCIA pump has good analgesic effect and less adverse reactions in patients with lower limb fractures after surgery, which is beneficial to improving the satisfaction of patients with postoperative analgesia. |
| Key words: Lower limb fracture Multimodal analgesia Adductor canal block Popliteal sciatic nerve block |
