...惠2.5万元 置换享3000元油卡
孙婷辉 段思源
摘 要 目的:探讨小剂量咪达唑仑联合芬太尼进行老年全髋关节置换术后镇痛的有效性和安全性。方法:选择68例腰麻下行全款置换的ASA Ⅰ~Ⅲ级老年患者,随机分为两组各34例。对照组给予芬太尼单药处理,试验组给予0.1 mg/kg咪达唑仑+芬太尼联合处理,比较两组术后不同时间点静息状态下和运动状态下VAS评分、睡眠紊乱情况及不良反应。结果:试验组在术后4~48 h VAS评分、睡眠紊乱发生率及患者恶心、呕吐发生率均较对照组低(P<0.05)。结论:小剂量咪达唑仑联合芬太尼能有效地进行术后镇痛,且能改善患者术后睡眠质量和术后恶心、呕吐的发生率。
关键词 咪达唑仑 芬太尼 全髋关节置换 术后镇痛 睡眠质量
中图分类号:R971.3; R687.42 文献标志码:B 文章编号:1006-1533(2018)07-0024-04
Effect of low dose midazolam combined with fentanyl on postoperative analgesia in elderly patients undergoing total hip arthroplasty
SUN Tinghui*, DUAN Siyuan
(Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai 200082, China)
ABSTRACT Objective: To investigate the efficacy and safety of low dose midazolam combined with fentanyl for postoperative analgesia in elderly patients undergoing total hip arthroplasty. Methods: A total of 68 patients at ASAⅠ~Ⅲ undergoing total hip arthroplasty under lumbar anesthesia were randomly divided into a control group (giving fentanyl 18 mg/kg only) and an experimental group (giving 0.1 mg/kg midazolam combined with fentanyl 18 mg/kg) with 34 cases each. VAS scores at rest and under exercise at different postoperative time points and the incidence of sleep disorder and adverse reactions after surgery were compared between the two groups. Results: VAS scores at postoperative 4 h, 6 h, 12 h, 24 h and 48 h and the incidence of sleep disorder and nausea and vomiting were lower in the experimental group than the control group (P<0.05) . Conclusion: Small dose of midazolam combined with fentanyl can effectively relieve postoperative pain, improve sleep quality and reduce the incidence of nausea and vomiting after operation.
KEy WORDS midazolam; fentanyl; total hip arthroplasty; postoperative analgesia; sleep quality
疼痛是组织损伤或潜在组织损伤所引起的不愉快感觉和情感反应。根据疼痛的持续时间以及损伤组织的愈合时间,将疼痛划分为急性疼痛和慢性疼痛。术后疼痛(postoperative pain)是手术后即刻发生的急性疼痛(通常持续不超过7 d),也是临床最常见和最需紧急处理的急性疼痛[1]。
随着经济的发展和老龄化进程的加速,老年患者因股骨头坏死而行全髋关节置换术的患者越来越多。而全髋关节置换术后引起的疼痛,被定义为重度疼痛,但考虑到老年患者的重要组织器官储备功能下降,对阿片类镇痛药敏感、耐受性差,因此术后镇痛的安全性要求更高。多模式镇痛,是近年来倡导的一种联合镇痛模式,旨在联合应用不同作用机制的镇痛药物或不同的镇痛方法,获得更好的镇痛效果和/或降低不良反应的发生率[2]。本研究旨在探讨对比联合小剂量咪达唑仑和芬太尼单用对老年全髋关节置换术患者术后镇痛的安全性和有效性。
1 方法
1.1 试验设计
选择本院2016年1月—2017年9月間择期腰麻+连续硬膜外麻醉下行全髋关节置换术老年患者68例,其中男37例,女31例,美国麻醉医师协会(ASA)分级为Ⅰ~Ⅲ级,年龄65~90岁,平均年龄(76.4±6.8)岁,体重45~78 kg。采用随机数字表法将受试者随机分为试验组(咪达唑仑+芬太尼)和对照组(芬太尼),每组34例。两组患者采用相同的术中麻醉和维持药物。
1.2 药品及器材
枸橼酸芬太尼注射液(宜昌人福药业,规格10 ml:0.5 mg);咪达唑仑注射液(江苏恩华药业股份有限公司,规格1 ml:5 mg);术后镇痛泵(型号AM320,AM330,ACE Medical Co., Ltd.)。