目的 评价罗哌卡因行胸内肋间神经阻滞时联合氟比洛芬酯用于肋骨骨折固定术后患者镇痛的效果。方法 选取2014-02至2016-02首都医科大学密云教学医院80例肋骨骨折手术病例,随机分为两组,每组40例,罗哌卡因行肋间神经阻滞联合静脉氟比洛芬酯观察组(观察组)和单纯镇痛泵对照组(对照组)。对两组术后疼痛评分、肺部感染、药物不良反应,以及患者术后心理评估进行对比。结果 观察组较对照组在术后疼痛、肺部并发症及药物不良反应(嗜睡、恶心/呕吐、皮肤瘙痒和呼吸抑制)方面均有明显降低,其中3、5、8、12 h时观察组疼痛评分均低于对照组,差异有统计学意义(P<0.05);观察组患者发生术后肺部感染率为0.05%,低于对照组0.2%。药物不良反应中观察组嗜睡2例、恶心3例、呕吐1例、皮肤瘙痒1例、呼吸抑制1例均低于对照组,差异有统计学意义(P<0.05)。观察组的心理负担总分均低于对照组;观察组的力量维度、坚韧维度、乐观维度及心理弹性总分均高于对照组。结论 应用罗哌卡因行胸内肋间神经阻滞联合静脉氟比洛芬酯对减少患者术后疼痛有明显的效果,值得推广。
Abstract
Objective To evaluate the effect of intercostal nerve blocks using ropivacaine combined with flurbiprofen axetil for postoperative analgesia in patients following rib fracture fixation.Methods We retrospectively analyzed 80 patients with rib fracture, who underwent fixation between February 2014 and February 2016. The patients were randomly divided into two groups. Group A received intercostal nerve blocks using ropivacaine combined with intravenous flurbiprofen (40 cases) while Group B used analgesia pumps alone (40 cases). Postoperative pain scores, lung infections, adverse drug reactions and results of postoperative psychological assessment were compared between the two groups.Results Postoperative pain scores and incidence rates of pulmonary complications and adverse drug reactions (lethargy, nausea/vomiting, pruritus and respiratory depression) were significantly lower in Group A. The average scores of pain in the observation group were lower those in the control group (3,5,8,12 h) (P<0.05). Psychological burden scores in Group A were lower than in Group B, while resilience and optimism scores were higher in Group A. There were 2 cases of drowsiness, 3 cases of nausea, 1 case of vomiting, 1 case of skin pruritus, and 1 case of respiratory depression in the observation group, which was better than in the control group.Conclusions Intercostal nerve blocks using ropivacaine combined with flurbiprofen axetil can more effectively reduce postoperative pain, alleviate psychological burden and is worthy of clinical popularization.
关键词
肋骨骨折固定术 /
罗哌卡因 /
氟比洛芬酯 /
精准医疗
Key words
rib fracture fixation /
ropivacaine /
flurbiprofen axetil /
analgesia
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