无线镇痛泵对老年患者髋关节置换术后镇痛的效果观察
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摘要
目的探讨无线镇痛泵用于老年患者髋关节置换术后镇痛的可行性及有效性。方法将100例我院2016年5月~2017年5月需术后镇痛的老年髋关节置换术后患者随机分为两组,试验组50例,采用无线镇痛泵;对照组50例,采用传统电子镇痛泵。观察应用数字疼痛评分法(NRS)分别于术后出PACU、24 h、48 h、72 h的评价患者的疼痛程度;患者对自控键的总按压次数、有效按压次数;麻醉医生的有效处理时间;测评患者总体满意度及不良反应的发生情况;评估两组患者的术后认知功能。结果两组患者术后各时点的NRS评分比较无统计学差异(P>0.05);两组患者按压自控键的总次数、有效按压次数比较无统计学差异(P>0.05);麻醉医生有效处理时间:试验组为(11.0±2.53)min,对照组为(18.0±3.11)min,有统计学差异(P<0.05);试验组患者的总体满意度高于对照组,差异有统计学意义(P<0.05);两组患者不良反应发生率无明显差异(P>0.05);两组患者术后简易精神状态量表评分及术后认知功能障碍的发生率比较均无差异(P>0.05)。结论无线镇痛泵系统用于老年患者髋关节置换术后的镇痛管理安全可行,利于患者术后快速康复。
Objective To investigate the feasibility and the effectiveness of wireless analgesic pump on the postoperative analgesia of hip replacement in elder patients. Methods 100 elder patients demanding postoperative analgesia after hip replacement in our hospital from May 2016 to May 2017 were randomized into two groups. 50 patients in study group were treated with wireless analgesic pump while 50 patients in control group were treated with conventional elec tronic analgesic pump. The following indicators were observed: the degree of pain when discharge from PACU, 24 h, 48 h and 72 h after the operation was assessed using numerical rating scale(NRS) for pain, total press time and effective press time of self-control button, effective processing time of anesthesiologist, the total satisfactory rate and the incidence of complications, the postoperative cognitive function of patients in two groups. Results The NRS score at each time point in two groups was not statistically different(P>0.05). The total press time and effective press time of selfcontrol button in two groups were not statistically different(P>0.05). The effective processing time of anesthesiologist in study group was(11.0±2.53)min, which was significantly different from that in control group[(18.0±3.11)min](P<0.05).The total satisfactory rate of patients in study group was statistically higher than that in control group(P<0.05). The in cidence of complications in two groups was not significantly different(P>0.05). The score of the mini-mental state examination and the incidence of cognitive dysfunction in two groups were not statistically different(P>0.05). Conclusion It is safe and feasible to use wireless analgesic pump on the postoperative analgesia management of hip replacement in elder patients. It could be helpful for patients to recover soon.
Objective To investigate the feasibility and the effectiveness of wireless analgesic pump on the postoperative analgesia of hip replacement in elder patients. Methods 100 elder patients demanding postoperative analgesia after hip replacement in our hospital from May 2016 to May 2017 were randomized into two groups. 50 patients in study group were treated with wireless analgesic pump while 50 patients in control group were treated with conventional elec tronic analgesic pump. The following indicators were observed: the degree of pain when discharge from PACU, 24 h, 48 h and 72 h after the operation was assessed using numerical rating scale(NRS) for pain, total press time and effective press time of self-control button, effective processing time of anesthesiologist, the total satisfactory rate and the incidence of complications, the postoperative cognitive function of patients in two groups. Results The NRS score at each time point in two groups was not statistically different(P>0.05). The total press time and effective press time of selfcontrol button in two groups were not statistically different(P>0.05). The effective processing time of anesthesiologist in study group was(11.0±2.53)min, which was significantly different from that in control group[(18.0±3.11)min](P<0.05).The total satisfactory rate of patients in study group was statistically higher than that in control group(P<0.05). The in cidence of complications in two groups was not significantly different(P>0.05). The score of the mini-mental state examination and the incidence of cognitive dysfunction in two groups were not statistically different(P>0.05). Conclusion It is safe and feasible to use wireless analgesic pump on the postoperative analgesia management of hip replacement in elder patients. It could be helpful for patients to recover soon.
引文
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[8]陶伟萍,毛巧燕,杨建萍.脊柱手术患者家庭关怀度与术后认知功能障碍的相关性分析[J].中华行为医学与脑科学杂志,2013,22(10):908-910.
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[10]张玉辉,高亚坤,肖连波,等.右美托咪定对老年心脏瓣膜置换术患者心肌保护和脑保护的影响[J].中国老年学杂志,2015,35(16):4606-4608.
[11]Lindley E,Milligan K,Farmer R,et a1.Patient—controlled transdermal fentanyl versus intravenous morphine pump after spine surgery[J].Orthopedics,2015,38(9):e819-e824.
[12]姜徽,李元海,周磊,等.不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响[J].临床麻醉学杂志,2016,32(5):472-475.
[13]Koh JC,Song Y,Kim SY,et a1.Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients:A retrospective analysis of 2,435 patients[J].J Pain Res,2017,12(10):897-904.
[14]Heesen M,B觟hmer J,Klmhr S,et al.The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor,maternal,and neonatal outcomes:A systematic review and meta-analysis[J].Anesth Analg,2015,121(1):149-158.
[15]袁振飞,高清贤,尹治清.地佐辛联合舒芬太尼用于心脏手术后无线镇痛的效果[J].实用疼痛学杂志,2014,10(6):450-453.
[16]Juliebo V,Bjoro K,Krogseth M,et al.Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture[J].J Am Geriatr Soc,2009,57(8):1354~1361.
[17]王彬,张其亮,李军,等.老年髋关节置换术后谵妄和认知功能障碍的危险因素[J].临床麻醉学杂志,2013,29(8):785-788.
[18]朱滨.基于Wi-Fi无线技术的智能镇痛泵系统设计[J].临床医学工程,2012,19(8):1243-1244.
[19]严峰,李军,王浩杰,等.无线数字信息化技术用于术后患者镇痛管理的研究和分析[J].中国医师杂志,2016,18(1):88-91.
[20]何苗,冯艺,陈杰.无线远程镇痛泵监控系统用于术后患者镇痛管理的可行性及有效性研究[J].中国疼痛医学杂志,2014,20(5):308-313.
[2]Stacey B,Rudy T,Nellhaus D.Management of patientcontrolled analgesia:A comparison of primary surgeons and a dedicated pain service[J].Anesthesia&Analgesia,1997,85(1):130-134.
[3]Karanikolas M,Aretha D,Monantera G,et al.Intravenous fentanyl patient-controlled analgesia for perioperative treatment of neuropathic/ischaemic pain in haemodialysis patients:A case series[J].Journal of Clinical Pharmacy and Therapeutics,2010,35(5):603-608.
[4]Grass J.Patient-controlled analgesia[J].Anesthesia&Analgesia,2005,101(5S):S44-S61.
[5]Fong HK,Sands LP,Leung JM.The role of postoperative analgesia in delirium and cognitive decline inelderly patients:A systematic review[J].Anesth Analg,2006,102(4):1255-1266.
[6]Doyle D,Vicente K.Electrical short circuit as a possible cause of death inpatients on PCA machines:Report on an opiate overdose and a possible preventiveremedy[J].Anesthesiology,2001,94(5):940.
[7]Choi YM,Byeon GJ,Park SJ,et al.Postoperative analgesic efficacy of single-shot and continuous transversus abdominis plane block after laparoscopic cholecystectomy:A randomized controlled clinical trial[J].J Clin Anesth,2017,39:146-151.
[8]陶伟萍,毛巧燕,杨建萍.脊柱手术患者家庭关怀度与术后认知功能障碍的相关性分析[J].中华行为医学与脑科学杂志,2013,22(10):908-910.
[9]Harikesavan K,Chakravarty RD,Maiya AG,et al.Hip abductor strengthening improves physical function following total knee replacement:One-year follow-up of a randomized pilot study[J].Open Rheumatol J,2017,31(11):30-42.
[10]张玉辉,高亚坤,肖连波,等.右美托咪定对老年心脏瓣膜置换术患者心肌保护和脑保护的影响[J].中国老年学杂志,2015,35(16):4606-4608.
[11]Lindley E,Milligan K,Farmer R,et a1.Patient—controlled transdermal fentanyl versus intravenous morphine pump after spine surgery[J].Orthopedics,2015,38(9):e819-e824.
[12]姜徽,李元海,周磊,等.不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响[J].临床麻醉学杂志,2016,32(5):472-475.
[13]Koh JC,Song Y,Kim SY,et a1.Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients:A retrospective analysis of 2,435 patients[J].J Pain Res,2017,12(10):897-904.
[14]Heesen M,B觟hmer J,Klmhr S,et al.The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor,maternal,and neonatal outcomes:A systematic review and meta-analysis[J].Anesth Analg,2015,121(1):149-158.
[15]袁振飞,高清贤,尹治清.地佐辛联合舒芬太尼用于心脏手术后无线镇痛的效果[J].实用疼痛学杂志,2014,10(6):450-453.
[16]Juliebo V,Bjoro K,Krogseth M,et al.Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture[J].J Am Geriatr Soc,2009,57(8):1354~1361.
[17]王彬,张其亮,李军,等.老年髋关节置换术后谵妄和认知功能障碍的危险因素[J].临床麻醉学杂志,2013,29(8):785-788.
[18]朱滨.基于Wi-Fi无线技术的智能镇痛泵系统设计[J].临床医学工程,2012,19(8):1243-1244.
[19]严峰,李军,王浩杰,等.无线数字信息化技术用于术后患者镇痛管理的研究和分析[J].中国医师杂志,2016,18(1):88-91.
[20]何苗,冯艺,陈杰.无线远程镇痛泵监控系统用于术后患者镇痛管理的可行性及有效性研究[J].中国疼痛医学杂志,2014,20(5):308-313.