改良自控式镇痛泵的使用方法对全髋关节置换术后镇痛效果的影响

摘要

目的 探讨全髋关节置换术后使用自控式镇痛泵(patient-controlled analgesia,PCA)的患者引入超前镇痛的观念,超前定时预防性加注镇痛泵药物镇痛效果.方法 将2014年1~12月我科收治的113例全髋关节置换术后使用PCA的患者按数字表法随机分为两组:对照组58例,术后常规使用PCA;改良组55例,术后由责任护士对患者实施全程一对一宣教及护理,全面负责PCA操作过程,并从手术结束后6 h起,每间隔1.5 h由责任护士给予按压加注按钮超前镇痛,严密观察并比较镇痛效果和不良反应.结果 改良组在术后12 h、18 h和24 h疼痛评分明显低于对照组,差异均有统计学意义(均P<0.05);两组术后在恶心呕吐、尿潴留、呼吸抑制、血压下降等不良反应方面比较,差异均无统计学意义(均P>0.05).结论 全髋关节置换术后使用PCA患者,定时预防性加注镇痛泵药物,镇痛效果确切.%Objective To investigate the effects of modified patients-controlled intravenous analgesia for introducing concept of preemptive analgesia in the patients after total hip arthroplasty (THA). Methods One hundred and thirteen patients undergoing THA between January and December in 2014 were randomly divided into two groups:experimental group (55 cases) given modified patients-controlled analgesia (PCA) and whole process of nursing, and 6 h after operation, pressure filling for analgesia was done every 1.5 h; control group (58 cases) given postoperative routine PCA. Results In the experimental group, the VAS value was significantly reduced as compared with the control group at 12, 18 and 24 h after THA. The incidence of adverse drug reactions showed no significant difference after operation between two groups (P>0.05). Conclusion The modified methods of patients-controlled intravenous analgesia have better effect in reducing postoperative pain in patients undergoing THA without increased the incidence of the adverse drug reactions.