丙帕他莫联合静脉自控镇痛泵对75岁以上老年髋部骨折患者术后的镇痛效果

目的探讨丙帕他莫联合舒芬太尼静脉自控镇痛泵(PCIA)对75岁以上老年髋部骨折术后的镇痛效果及安全性。方法将本院2015年6月至2016年6月216例75岁以上接受髋部手术的患者随机分为观察组和对照组,每组各108例;对照组给予PCIA,观察组给予丙帕他莫联合PCIA。观察2组患者术后12 h内的镇痛效果、追加镇痛药物情况以及术后不良反应发生情况。应用视觉模拟评分法(VAS)和Ramsay镇静评分评估患者术后镇痛效果。采用SPSS 17.0软件对数据进行统计学分析。计量资料采用方差分析,计数资料采用X2检验。结果术后2 h,2组间VAS和Ramsay评分差异无统计学意义;术后6 h和12 h,观察组VAS评分低于对照组,Ramsay评分高于对照组,差异有统计学意义(P0.05)。观察组术后2、6和12 h的舒芬太尼追加量均小于对照组,6 h和12 h时差异有统计学意义(P0.05)。观察组患者术后不良反应发生率显著低于对照组,差异有统计学意义(8.70%vs 37.0%,P0.05)。结论 75岁以上老年髋部骨折术后患者联合使用丙帕他莫和PCIA可有效减轻术后疼痛,尤其显著减少因应用阿片类药物导致的不良反应。

Postoperative analgesia of propacetamol combined with patient controlled intravenous analgesia in the elderly over 75 years with hip fracture

Objective To investigate the analgesic effect and safety of propacetamol combined with patient controlled intravenous analgesia (PCIA) in the elderly over 75 years with hip fracture. Methods A total of 216 patients over 75 years suffering from hip fractures and undergoing surgical treatment in our hospital from June 2015 to June 2016 were recruited in this study. Then the patients were randomly divided into the observation group and control group, with 108 patients in each group. The patients of the observation group were given propacetamol combined with PCIA after operation, while those of the control group only PCIA. The analgesic effect, PCIA sufentanil consumption, and incidence of adverse reactions were observed within 12 h after operation. The effect of analgesia was evaluated by visual analogue scale (VAS) and Ramsay scores. SPSS statistics 17.0 was used to perform the statistical analysis. Quantitative data were compared with variance analysis, and categorical data with Chi-square test. Results In 2 h after surgery, VAS and Ramsay scores were not statistically different between two groups. In 6 h and 12 h after surgery, the observation group had significantly lower VAS and higher Ramsay scores compared with the control group (P<0.05). When compared with the control group, the observation group had significantly less PCIA sufentanil consumption in 2,6 and 12 h after surgery, with significant difference in 6 and 12 h time points (P<0.05). The observation group had obviously lower incidence of opioid-related adverse reactions than control group (8.7% vs 37.0%, P<0.05). Conclusion Combined application of propacetamol and PCIA can effectively offer better pain relief postoperatively, reduce sufentanil consumption, and especially decrease the adverse effects caused by opioids in the over-75-year-old patients after hip fracture surgery.