鸡尾酒疗法对创伤性骨折术后镇痛的效果观察
|
摘要
目的探讨鸡尾酒疗法对创伤性骨折术后的镇痛效果。方法 30例创伤性骨折患者随机分为对照组和观察组,各15例。对照组术前口服洛索洛芬,术中及术后使用氟比洛芬酯静脉滴注,功能锻炼前30 min加服洛索洛芬。观察组在对照组的基础上增加术中鸡尾酒疗法,即手术植入内固定材料后,在骨折周围深部软组织注射鸡尾酒混合液,罗哌卡因100 mg、吗啡5 mg、肾上腺素(1∶1 000)0.3 mL加入0.9%氯化钠注射液混合至100 mL。观察2组疼痛视觉模拟评分(VAS)及功能锻炼的依从性。结果观察组术后静息状态下6、12、24、36、72 h及功能锻炼后30 min VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组患者功能锻炼依从性优于对照组,差异有统计学意义(P<0.05)。结论鸡尾酒疗法运用于创伤性骨折术后镇痛,可以有效降低术后早期静息状态下和活动后的疼痛感,提高患者功能锻炼依从性。
Objective To investigate the effect of local infiltration analgesia( cocktail therapy)on postoperative pain control in patients undergoing surgery for traumatic fracture. Methods Totally 30 patients undergoing surgery for traumatic fracture were assigned to the control group( n = 15) and the observation group( n = 15). In the control group,patients were given a combination solution( oral premedication with loxoprofen,intraoperative and postoperative administration of intravenous flurbiprofen axeti,oral loxoprofen at 30 minutes before functional training). In the observation group,extra combined administration of local anesthetics,epinephrine and other adjuvants was carried out after implantation of internal fixation material. The visual analogue scale on pain( VAS) and compliance of functional training were evaluated. Results The VAS score of patients was lower in the patients than that of controls at 6,12、24、36、72 h after operation and 30 minutes after functional training,respectively( P < 0. 05). Patients of observation group had a higher degree of functional training compliance( P < 0. 05). Conclusion The cocktail therapy is potentially effective to relieve the postoperative and post-exercise pain degree of patients undergoing surgery for traumatic fracture.
Objective To investigate the effect of local infiltration analgesia( cocktail therapy)on postoperative pain control in patients undergoing surgery for traumatic fracture. Methods Totally 30 patients undergoing surgery for traumatic fracture were assigned to the control group( n = 15) and the observation group( n = 15). In the control group,patients were given a combination solution( oral premedication with loxoprofen,intraoperative and postoperative administration of intravenous flurbiprofen axeti,oral loxoprofen at 30 minutes before functional training). In the observation group,extra combined administration of local anesthetics,epinephrine and other adjuvants was carried out after implantation of internal fixation material. The visual analogue scale on pain( VAS) and compliance of functional training were evaluated. Results The VAS score of patients was lower in the patients than that of controls at 6,12、24、36、72 h after operation and 30 minutes after functional training,respectively( P < 0. 05). Patients of observation group had a higher degree of functional training compliance( P < 0. 05). Conclusion The cocktail therapy is potentially effective to relieve the postoperative and post-exercise pain degree of patients undergoing surgery for traumatic fracture.
引文
[1]刘建州.创伤性骨盆骨折合并失血性休克临床体会[J].中国实用医刊,2015,42(17):9-10.
[2]KANG H,HA Y C,KIM J Y,et al.Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture:a randomized,controlled study[J].J Bone Joint Surg Am,2013,95(4):291-296.
[3]BUSCH C A,SHORE B J,BHANDARI R,et al.Efficacy of periarticular m ultim odal drug injection in total knee arthroplasty.A random ized trial.[J].J Bone Joint Surg Am,2006,88(5):1225-1228.
[4]李金洁,王云芸,赵英,等.鸡尾酒疗法对老年全膝关节置换术后镇痛的影响[J].中国老年学杂志,2016,36(15):3769-3770.
[5]BARATTA J L,GANDHI K,VISCUSI E R.Perioperative pain management for total knee arthroplasty[J].J Surg Orthop Adv,2014,23(1):22-36.
[6]FUJII-ABE K,UMINO M,FUKAYAMA H,et al.Enhancement of Analgesic Effect by Combination of Non-Noxious Stimulation and Noxious Stimulation in Humans[J].Pain Pract,2016,16(2):141-147.
[7]MESSEROTTI B S,RING C,PALOMBA D,et al.Cortical and autonomic responses to noxious stimulation during anesthesia in cardiac surgery patients are moderated by preanesthetic blood pressure levels[J].Psychophysiology,2012,49(5):697-703.
[8]张燕.早期护理干预在老年腰椎压缩性骨折术后疼痛中的应用[J].护理实践与研究,2012,9(22):27-28.
[9]林秀芹.创伤性骨折患者术后的心理护理[J].中国医药科学,2010,2(2):150-151.
[10]PENPRASE B,BRUNETTO E,DAHMANI E,et al.The Efficacy of Preemptive Analgesia for Postoperative Pain Control:A Systematic Review of the Literature[J].AORN J,2015,101(1):94-105.
[11]ZHANG J,WANG Y,YANG G,et al.Effects of comprehensive rehabilitation training in combination w ith multi-mode analgesia on body function recovery after tumor-type knee replacement[J].Pak J M ed Sci,2016,32(5):1240-1245.
[12]Pan Y S,Hu Y F,Tian F B,et al.Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery:a randomized controlled study[J].Int J Clin Exp M ed,2015,8(6):9862-9868.
[13]王东.罗哌卡因、芬太尼、肾上腺素混合液术中膝关节浸润麻醉对老年TKA患者术后PCIA效果的影响[J].医学临床研究,2017,34(9):1794-1796.
[14]胡妙兰.老年髋部骨折患者术后功能锻炼现状及影响因素分析[J].护理学报,2010,17(8):37-39.
[15]刘梅,刘林,许勤,等.持续质量改进在骨创伤患者疼痛管理中的应用[J].中华护理杂志,2012,47(10):872-875.
[16]王小刚,刘珂,张振,等.鸡尾酒式镇痛混合剂治疗全膝关节置换术后早期疼痛疗效观察[J].中华实用诊断与治疗杂志,2012,26(12):1244-1245.
[17]STIVALA A,HARTLEY G.The Effects of a PilatesBased Exercise Rehabilitation Program on Functional Outcome and Fall Risk Reduction in an Aging Adult Status-Post Traumatic Hip Fracture due to Fall.[J].J Geriatr Phys Ther,2014,37(3):136-145.
[2]KANG H,HA Y C,KIM J Y,et al.Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture:a randomized,controlled study[J].J Bone Joint Surg Am,2013,95(4):291-296.
[3]BUSCH C A,SHORE B J,BHANDARI R,et al.Efficacy of periarticular m ultim odal drug injection in total knee arthroplasty.A random ized trial.[J].J Bone Joint Surg Am,2006,88(5):1225-1228.
[4]李金洁,王云芸,赵英,等.鸡尾酒疗法对老年全膝关节置换术后镇痛的影响[J].中国老年学杂志,2016,36(15):3769-3770.
[5]BARATTA J L,GANDHI K,VISCUSI E R.Perioperative pain management for total knee arthroplasty[J].J Surg Orthop Adv,2014,23(1):22-36.
[6]FUJII-ABE K,UMINO M,FUKAYAMA H,et al.Enhancement of Analgesic Effect by Combination of Non-Noxious Stimulation and Noxious Stimulation in Humans[J].Pain Pract,2016,16(2):141-147.
[7]MESSEROTTI B S,RING C,PALOMBA D,et al.Cortical and autonomic responses to noxious stimulation during anesthesia in cardiac surgery patients are moderated by preanesthetic blood pressure levels[J].Psychophysiology,2012,49(5):697-703.
[8]张燕.早期护理干预在老年腰椎压缩性骨折术后疼痛中的应用[J].护理实践与研究,2012,9(22):27-28.
[9]林秀芹.创伤性骨折患者术后的心理护理[J].中国医药科学,2010,2(2):150-151.
[10]PENPRASE B,BRUNETTO E,DAHMANI E,et al.The Efficacy of Preemptive Analgesia for Postoperative Pain Control:A Systematic Review of the Literature[J].AORN J,2015,101(1):94-105.
[11]ZHANG J,WANG Y,YANG G,et al.Effects of comprehensive rehabilitation training in combination w ith multi-mode analgesia on body function recovery after tumor-type knee replacement[J].Pak J M ed Sci,2016,32(5):1240-1245.
[12]Pan Y S,Hu Y F,Tian F B,et al.Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery:a randomized controlled study[J].Int J Clin Exp M ed,2015,8(6):9862-9868.
[13]王东.罗哌卡因、芬太尼、肾上腺素混合液术中膝关节浸润麻醉对老年TKA患者术后PCIA效果的影响[J].医学临床研究,2017,34(9):1794-1796.
[14]胡妙兰.老年髋部骨折患者术后功能锻炼现状及影响因素分析[J].护理学报,2010,17(8):37-39.
[15]刘梅,刘林,许勤,等.持续质量改进在骨创伤患者疼痛管理中的应用[J].中华护理杂志,2012,47(10):872-875.
[16]王小刚,刘珂,张振,等.鸡尾酒式镇痛混合剂治疗全膝关节置换术后早期疼痛疗效观察[J].中华实用诊断与治疗杂志,2012,26(12):1244-1245.
[17]STIVALA A,HARTLEY G.The Effects of a PilatesBased Exercise Rehabilitation Program on Functional Outcome and Fall Risk Reduction in an Aging Adult Status-Post Traumatic Hip Fracture due to Fall.[J].J Geriatr Phys Ther,2014,37(3):136-145.