氟比洛芬脂聯(lián)合側隱窩阻滯在老年患者下肢骨科手術超前鎮(zhèn)痛中的應用

曾建峰++黃志思+劉江梅+胡兆云+唐超

[摘要]目的 觀察氟比洛芬脂聯(lián)合側隱窩阻滯在老年患者下肢骨科手術超前鎮(zhèn)痛中的應用效果。方法 選取2016年1～12月在我院擇期行下肢骨科手術的老年患者60例為研究對象，采用隨機數(shù)字表法分成A、B、C組，每組20例。A組采用氟比洛芬脂+側隱窩阻滯作為聯(lián)合超前鎮(zhèn)痛；B組采用側隱窩阻滯并術后連續(xù)側隱窩鎮(zhèn)痛；C組采用單純連續(xù)硬膜外阻滯。觀察三組側隱窩阻滯和硬膜外阻滯穿刺成功率和穿刺時間，術后VAS疼痛評分及住院天數(shù)和住院費用等。結果 A組術后1、4、16、24、48 h的VAS評分均明顯低于B、C組，差異有統(tǒng)計學意義（P<0.05），B組各時間VAS評分低于C組，但差異無統(tǒng)計學意義（P>0.05）；A組穿刺成功率為95.0%，明顯高于B、C組的85.0%、80.0%，穿刺時間也較B、C組明顯縮短，差異均有統(tǒng)計學意義（P<0.05）；A組住院時間、住院費用均較B組和C組明顯縮短和減少，差異有統(tǒng)計學意義（P<0.05）。結論 臨床中針對老年患者下肢骨科手術中采用氟比洛芬脂聯(lián)合側隱窩阻滯超前鎮(zhèn)痛，操作簡便，安全有效，穿刺成功率高，并發(fā)癥少，具有推廣意義。

[關鍵詞]氟比洛芬脂；側隱窩阻滯；下肢骨科手術；超前鎮(zhèn)痛

[中圖分類號] R614.2+4 [文獻標識碼] A [文章編號] 1674-4721（2017）05（b）-0100-03

Application of Flurbiprofen Axetil combined with lateral recess block in preemptive analgesia in elderly patients undergoing the orthopedics operation of lower limb

ZENG Jian-feng1 HUANG Zhi-si2 LIU Jiang-mei3 HU Zhao-yun1 TANG Chao3

1.Department of Anesthesia，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China；2.Operating Room，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China；3.Department of Orthopedics and Traumatology，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China

[Abstract]Objective To observe the application effect of Flurbiprofen Axetil combined with lateral recess block in preemptive analgesia in elderly patients undergoing the orthopedics operation of lower limb.Methods 60 elderly patients scheduled for lower extremity orthopedic surgery from Janurary to December 2016 in our hospital were selected and they were divided into group A，B and C by random number table，and there were 20 cases in each group.Group A was given Flurbiprofen Axetil combined with lateral recess block for preemptive analgesia.Group B was given lateral recessive obstruction and postoperative continuous lateral recess analgesia.Group C was given simple continuous epidural block.The success rate of puncture for lateral recessive obstruction and continuous epidural block，and puncture time，postoperative VAS pain score，hospital stay and hospitalization cost and so on were observed.Results The VAS score of group A were significantly lower than those of group B and group C at 1，4，16，24，48 h after operation （P<0.05）.The VAS score of group B was lower than that of group C，but the difference was not statistically （P>0.05）.The success rate of group A was 95.0%，which was significantly higher than that of group B and group C （85.0% and 80.0%），and the time of puncture was shorter than that of group B and C，the difference was statistically significant （P<0.05）.The time of hospitalization and hospitalization in group A were significantly shorter than those in group B and group C，the difference was statistically significant （P<0.05）.Conclusion The clinical application of Flurbiprofen Axetil combined with lateral recessive obstruction in elderly patients with orthopedic surgery is simple，safe and effective.The success rate of puncture is high and the complication is less.

[Key words]Flurbiprofen Axetil；Lateral recess obstruction；Orthopedics operation of lower limb；Preemptive analgesia

隨著我國人均壽命的顯著增長，老年骨科患者也在增加，其中下肢骨科手術患者術后手術部位疼痛劇烈，活動時尤為嚴重，疼痛高峰期主要集中在術后3 d內(nèi)，不僅影響全身情況的恢復，嚴重并發(fā)癥增多，而且患者因疼痛而懼怕功能鍛煉，增加術后肺部并發(fā)癥的發(fā)生及術后下肢血栓的發(fā)生，影響術后的康復[1-2]，因此，充分鎮(zhèn)痛是下肢骨科手術術后快速康復的核心與關鍵，只有充分鎮(zhèn)痛，術后的早期康復訓練才能得以保證，目前鎮(zhèn)痛主要有靜脈注射或口服阿片類等藥物或者硬膜外置管持續(xù)給藥鎮(zhèn)痛，但是因其各有相關并發(fā)癥或效果欠佳，飽受爭議[3-4]，因此，尋找合適理想鎮(zhèn)痛方式是麻醉界一直探索的問題。……