硬膜外自控镇痛泵(PCEA)应用于跟骨骨折内固定术后疼痛控制的临床疗效及安全性研究
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摘要
目的评估硬膜外自控镇痛泵(PCEA)在跟骨骨折内固定术后疼痛控制方面的临床疗效和安全性。方法系统回顾分析本院2015年6月—2017年12月行切开复位内固定治疗的跟骨骨折患者资料,根据术后是否留置硬膜外自控镇痛泵分为两组,PCEA组11例,非PCEA组14例,记录两组患者术后当晚、第1天、第2天VAS评分、疼痛控制满意度与睡眠满意度、额外毒麻类镇痛药物的使用情况和不良反应、术后并发症、住院时间。结果两组患者ASA麻醉分级和骨折类型比较差异无统计学意义。PCEA组患者术后当晚、第1天VAS评分明显低于非PCEA组(P <0.05),术后第2天比较差异无统计学意义。PCEA组患者镇痛满意度和睡眠满意度均明显高于非PCEA组(P <0.05),且额外毒麻类镇痛药物使用次数少于非PCEA组(P <0.05)。两组不良反应情况、术后并发症和住院时间比较,差异均无统计学意义。结论硬膜外自控镇痛泵(PCEA)应用于跟骨骨折内固定术后患者能达到良好缓解疼痛的作用,且能改善患者睡眠,减少术后额外毒麻类镇痛药物的使用,但有一定比率的不良反应。
Objective To evaluate the effectivity and safety of PCEA on postoperative pain control after calcaneal fracture fixation. Methods Data of patients who had undergone ORIF of calcaneal fracture from June 2015 to December 2017 in our hospital were retrospective analysed. They were divided into two groups according to whether or not received PCEA postoperation, and there were 11 cases in PCEA group and 14 cases in non-PCEA group. VAS scores, pain control satisfaction and sleep satisfaction, the use of additional narcotic analgesics and adverse reactions, postoperative complications and hospitalization time were recorded in the two groups on the operative night, the first day and the second day after operation. Results There was no significant difference in ASA anesthesia grade and fracture type between the two groups. The VAS score of PCEA group was significantly lower than that of nonPCEA group on the same night and the first day after operation(P < 0.05), but there was no significant difference on the second day after operation. Analgesic satisfaction and sleep satisfaction in PCEA group were significantly higher than those in non-PCEA group(P < 0.05), and the use of additional narcotic analgesics was less than that in non-PCEA group(P < 0.05). There was no significant difference in adverse reactions, postoperative complications and hospitalization time between the two groups. Conclusions The application of PCEA in patients with calcaneal fracture after internal fixation can achieve good pain relief effect, and can improve the sleep of patients, reduce the use of additional narcotic analgesics after operation, but there are a certain proportion of adverse reactions.
Objective To evaluate the effectivity and safety of PCEA on postoperative pain control after calcaneal fracture fixation. Methods Data of patients who had undergone ORIF of calcaneal fracture from June 2015 to December 2017 in our hospital were retrospective analysed. They were divided into two groups according to whether or not received PCEA postoperation, and there were 11 cases in PCEA group and 14 cases in non-PCEA group. VAS scores, pain control satisfaction and sleep satisfaction, the use of additional narcotic analgesics and adverse reactions, postoperative complications and hospitalization time were recorded in the two groups on the operative night, the first day and the second day after operation. Results There was no significant difference in ASA anesthesia grade and fracture type between the two groups. The VAS score of PCEA group was significantly lower than that of nonPCEA group on the same night and the first day after operation(P < 0.05), but there was no significant difference on the second day after operation. Analgesic satisfaction and sleep satisfaction in PCEA group were significantly higher than those in non-PCEA group(P < 0.05), and the use of additional narcotic analgesics was less than that in non-PCEA group(P < 0.05). There was no significant difference in adverse reactions, postoperative complications and hospitalization time between the two groups. Conclusions The application of PCEA in patients with calcaneal fracture after internal fixation can achieve good pain relief effect, and can improve the sleep of patients, reduce the use of additional narcotic analgesics after operation, but there are a certain proportion of adverse reactions.
引文
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[8]Williams B A.Forecast for perineural analgesia procedures for ambulatory surgery of the knee,foot,and ankle:applying patientcentered paradigm shifts[J].Int Anesth Clin,2012,50(1):126-142.
[9]Gartke K,Portner O,Taljaard M.Neuropathic symptoms following continuous popliteal block after foot and ankle surgery[J].Foot Ankle Int,2012,33(4):267-274.
[10]晏丽,陈武荣,苏喆.帕瑞布钠联合PCEA对骨科下肢手术患者术后镇痛的观察[J].中国医学创新,2011,8(34):46-47.
[11]Luiten W E,Schepers T,Luitse J S,et al.Comparison of continuous nerve block versus patient-controlled analgesia for postoperative pain and outcome after talar and calcaneal fractures[J].Foot Ankle Int,2014,35(11):1116-1121.
[12]郑军.术后应用PCEA泵导致腓总神经损伤3例[J].中原医刊,2007,34(20):71-72.
[2]董艳艳,石海花.坐骨神经阻滞在跟骨骨折术后疼痛控制中的应用[J].陕西医学杂志,2013,42(12):1686-1687.
[3]裴国献.洛徳伍德格林成人骨科学[M].北京:人民军医出版社,2014:1883-1891.
[4]Fuzier R,Cuvillon P,Delcourt J,et al.Peripheral nerve block in orthopaedic surgery:multicentric evaluation of practicing professionals and impact on the activity of the recovery room[J].Ann Fr Anesth Reanim,2007,26(9):761-768.
[5]Cooper J,Benirschke S,Sangeorzan B,et al.Sciatic nerve blockade improve early postoperative analgesia after open repair of calcaneus fractures[J].J Orthop Trauma,2004,18(4):197-201.
[6]Hunt K J,Higgins T F,Carlston C V,et al.Continuous peripheral nerve blockade as postoperative analgesia for open treatment of calcaneal fractures[J].J Orthop Trauma,2010,24(3):148-155.
[7]梁晓军.跟骨关节内骨折的切开复位内固定术[J].足踝外科电子杂志,2014,1(3):206-207.
[8]Williams B A.Forecast for perineural analgesia procedures for ambulatory surgery of the knee,foot,and ankle:applying patientcentered paradigm shifts[J].Int Anesth Clin,2012,50(1):126-142.
[9]Gartke K,Portner O,Taljaard M.Neuropathic symptoms following continuous popliteal block after foot and ankle surgery[J].Foot Ankle Int,2012,33(4):267-274.
[10]晏丽,陈武荣,苏喆.帕瑞布钠联合PCEA对骨科下肢手术患者术后镇痛的观察[J].中国医学创新,2011,8(34):46-47.
[11]Luiten W E,Schepers T,Luitse J S,et al.Comparison of continuous nerve block versus patient-controlled analgesia for postoperative pain and outcome after talar and calcaneal fractures[J].Foot Ankle Int,2014,35(11):1116-1121.
[12]郑军.术后应用PCEA泵导致腓总神经损伤3例[J].中原医刊,2007,34(20):71-72.