帕瑞昔布钠-舒芬太尼患者皮下自控镇痛对脊柱手术患者术后谵妄的影响

陈学强; 黄春贵; 余丽鲜; 杨云丽

帕瑞昔布钠-舒芬太尼患者皮下自控镇痛对脊柱手术患者术后谵妄的影响

1. 迪庆州人民医院麻醉科
2. 昆明总医院麻醉科

基金项目:

基金：云南省教育厅科学研究基金项目资助 (2010ZC179);

计量
- 文章访问数: 2124
- HTML全文浏览量: 765
- PDF下载量: 63
- 被引次数: 0
出版历程
- 收稿日期: 2017-09-10

The Effect of PCSA with Parecoxib Sodium and Sufentanil on the Postoperative Delirium in Patients after the Spinal Surgery

Funds:

基金：云南省教育厅科学研究基金项目资助 (2010ZC179);

摘要

摘要: 目的评价帕瑞昔布钠-舒芬太尼患者皮下自控镇痛技术 (patient controlled subcutaneous analgesia PCSA) 对脊柱手术患者术后谵妄的影响.方法择期全身麻醉下脊柱手术患者240例, ASAⅡ-Ⅲ, 年龄1864岁, 术后分为2组, NO-PCSA组 (术后疼痛时哌替啶2550 mg肌肉注射n=120) ;PCSA组 (术后PCSA:舒芬太尼0.9μg/ (kg·d) 帕瑞昔布纳120 mg+托烷司琼10 mg+生理盐水150 m L, 负荷剂量2 m L, 背景输注速率2m L/h, 单次按压剂量 (PCA) 0.5 m L, 锁定时间为15 min, VAS评分>5时哌替啶丁2550 mg肌肉注射n=120) .用视觉模拟评分法 (VAS评分) 分别对2组术后2、24、48、72 h进行疼痛评分;用谵妄评定法评估术后2、24、48、72 h内发生谵妄的情况.结果与NO-PCSA组比较, PCSA组术后3 d VAS评分明显下降, 且术后谵妄发生率降低 (P<0.05) , 差异有统计学意义.结论脊柱手术后帕瑞昔布钠-舒芬太尼患者皮下自控镇痛效果好, 且可降低术后谵妄的发生率.
- 患者皮下自控镇痛 /
- 脊柱手术 /
- 术后谵妄 /
- 手术后并发症
Abstract: Objective To investigate the effect of patient controlled subcutaneous analgesia (PCSA) of Sufentamil and Parecoxib sodium on the postoperative delirium in patients after the spinal surgery. Methods 240 patients with ASA Ⅱ-Ⅲ age 18-64 yrs after the spinal surgery were divided into two groups: group NO-PCSA (analgesic management: patients were accepted pethidine 25-50 mg intramuscular injection n = 120) ; group PCSA (analgesic management: patient controlled subcutaneous analgesia was started since skin suture with the following composition: Sufentanil 0.9 ug/ (kg.d) + Parecoxib sodium 120 mg + Tropisetron 10 mg + normal saline 150 m L. The PCSA setting was as follows: background infusion at 2 m L/h, a bolus dose of 0.5 m L, lockout interval 15 min. If the VAS was greater than 5, patient was accepted pethidine 25-50 mg intramuscular injection n = 120) .The effect of analgesia was assessed by visual analogue scale (VAS) . The delirium was assessed by the confusion assessment, VAS and delirium were recorded with in 2, 24, 48, 72 hours postoperatively. Results During the analgesia period, the VAS and the incidence of postoperative delirium were significantly lower in group PCSA than those in group NO-PCSA (P <0.05) . Conclusion PCSA of Sufentamil and Parecoxib sodium have a good postoperative analgesic effect in patients after the spinal surgery. It is an effective measure and the incidence of postoperative delirium can be decreased by reliefing postoperative pain.
- Patient Controlled Subcutaneous analgesia (PCSA) /
- Spinal surgery /
- Postoperative Delirium /
- Postoperative complication

HTML全文

参考文献(13)

[1]张承华, 麻伟青, 杨云丽, 等.全凭静脉麻醉下脊柱手术患者术后谵妄的危险因素[J].中华麻醉学杂志, 2010, 30 (9) :1062-1064.
[2]	[2]INOUYE S K, VAN DYCK C H, ALESSI C A, et al.Clarifying confusion:the confusion assessment method.A new method for detection of delirium[J].Ann Intern Med, 1990, 113 (12) :941-948.
[3]	[3]SI HB, YANG T M, ZENG Y, et al.Correlation between inflammatorycytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty[J].BMC Musculoskeletal Disorders, 2017, 18 (1) :265.
[4]	[4]MORI T, MIYAMOTO T, YOSHIDA H, et al.IL-1βand TNFα-initiated IL-6-STAT3 pathway is critical in mediating inflammatory cytokines and RANKL expression in inflammatory arthritis[J].Int Immunol, 20011, 23 (11) :701-712.
[5]	[5]PAPADOPOULOS G, KARANIKOLAS M, LIARMAKOPOU A, et al.Cerebral oximetry and cognitive dysfunction in elderly patients undergoing surgery for hip fractures:a prospective observational study[J].Open Orthop J, 2012, 6 (6) :400-406.
[6]	[6]TERRANDO N, ERIKSSON LI, RYU J K, et al.Resolving postoperative neuroinflammation and cognitive decline[J].Annals Neurology, 2011, 70 (6) :986-995
[7]	[7]MORRISON R S, MAGAZINER J, GILBERT M, et al.Relationship between pain and opioid analgesics on the development of delirium following hip fracture[J].J Gerontol A Biol Sci Med Sci, 2003, 58 (1) :76-81.
[8]	[8]MISTRALETTI G, CARLONI E, CIGADA M, et al.Sleep and delirium in the intensive care unit[J].Minerva Anestesio, 2008, 74 (6) :329-333.
[9]	[9]YILDIZELI B, OZYURTKAN M O, BATIREL H F, et al.Factors associated with postoperative delirium after thoracic surgery[J].Ann Thorac Surg, 2005, 79 (3) :1004-1009.
[10]张承华, 黄青青, 麻伟青.术后谵妄的研究进展[J].昆明医学院学报, 2009, 30 (3) :102-107.
[11]杨云丽, 魏辉明, 张承华, 等.氯诺昔康对老年患者全髋置换术后舒芬太尼皮下自控镇痛效果的影响[J].中国临床药理学与治疗学, 2014, 19 (2) :190-195.
[12]李娟, 唐朝亮, 康芳, 等.帕瑞昔布钠用于颅脑手术患者的镇痛效果及对血浆-内啡肽的影响[J].临床麻醉学杂志, 2012, 28 (6) :537-539.
[13]吴运香, 魏昕, 章敏, 等.帕瑞昔布钠对老年患者胃癌术后早期谁知功能的影响[J].临床麻醉学杂志, 2015, 30 (4) :320-322.

相关文章(20)

[1]	杨云丽, 李娜, 邱昌明, 普俊杰, 聂维, 李治贵. 超声引导下前路腰方肌阻滞对髋关节手术患儿术后镇痛效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230426
[2]	郭云瑞, 杨皓, 张业才, 张国云, 王德财, 角述兰, 张宁丽, 周臣. 腹部区域阻滞联合静脉镇痛对老年患者术后并发症的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221222
[3]	周银燕, 张宇, 白文娅, 沈艳娟, 邵建林, 赵国良. 直视下胸椎旁神经阻滞对胸科手术患者术后镇痛效果的影响, 昆明医科大学学报.
[4]	黄恒, 余文兴, 税磊, 何刚, 杨森. 双目手术显微镜与耳内镜下对行人工镫骨手术患者围术期指标、听力恢复及并发症的影响, 昆明医科大学学报.
[5]	李全, 张源, 梁跃伟, 阮锐, 赵学凌, 谢世伟, 张霖. 腰椎手术并发症-脑脊液漏的研究进展, 昆明医科大学学报.
[6]	湛自兰. 护理干预对脑出血非手术患者心理状态、并发症以及满意度的影响, 昆明医科大学学报.
[7]	吕毅. 足踝手术患者术后疼痛管理进展, 昆明医科大学学报.
[8]	唐加华. 自体血回输技术对行脊柱内固定手术患者术后血液流变学和骨折愈合的影响, 昆明医科大学学报.
[9]	李沛. 改良型Clavien手术并发症分级系统分析微通道经皮肾镜取石术后并发症, 昆明医科大学学报.
[10]	虞涛. 肺部实质性占位病变110例影像学及病理学诊断的准确性, 昆明医科大学学报.
[11]	杨云丽. 右美托咪啶对老年手术患者血清S-100β蛋白、NSE浓度的影响, 昆明医科大学学报.
[12]	杨艳. 皮肤免缝合技术在骨科脊柱手术中的应用, 昆明医科大学学报.
[13]	罗丽云. 20例外科手术后患者术后并发压疮的护理体会, 昆明医科大学学报.
[14]	杨云丽. 右美托咪啶对青少年特发性脊柱侧弯矫形术后谵妄的影响, 昆明医科大学学报.
[15]	方超. 结直肠肿瘤患者术后焦虑评分同术后并发症的相关性, 昆明医科大学学报.
[16]	杨亚青. 不同术后镇痛方式对腹腔镜胆囊切除术患者术后谵妄的影响, 昆明医科大学学报.
[17]	张承华. 右美托咪啶对肺叶切除术患者早期术后谵妄的影响, 昆明医科大学学报.
[18]	杨亚青. 七氟醚-舒芬太尼靶控麻醉对脊柱手术患者发生谵妄的影响, 昆明医科大学学报.
[19]	. 胸腰椎爆裂骨折28例前路手术并发症分析, 昆明医科大学学报.
[20]	张承华. 青壮年择期非心脏手术后谵妄的发生率及危险因素分析, 昆明医科大学学报.