摘要
目的 探究小剂量艾司氯胺酮联合舒芬太尼对胸腰椎骨折经皮椎弓根螺钉内固定患者术后静脉镇痛及认知功能的影响.方法 选择胸腰椎骨折需行经皮椎弓根螺钉内固定手术治疗的90 例患者为研究对象,采用随机双盲法将其分为两组.对照组患者静脉输注舒芬太尼,观察组患者静脉输注小剂量艾司氯胺酮联合舒芬太尼.比较两组患者的镇痛药物消耗情况、术后认知功能、疼痛评分、Ramsay镇静评分以及不良反应发生情况.结果 观察组患者静脉自控镇痛(PCIA)有效按压次数以及PCIA中舒芬太尼总用量均明显少于对照组,差异均有统计学意义(t分别=18.11、5.95,P均＜0.05).观察组患者术后3、6、24、48 h简易精神状态评价量表(MMSE)评分均明显高于对照组,差异均有统计学意义(t分别=7.60、4.37、7.51、10.91,P均＜0.05).观察组患者术后3、6、24、48 h静息和活动状态下的视觉模拟评分法(VAS)评分均低于对照组,差异均有统计学意义(t分别=12.17、10.69、14.33、12.40、8.74、12.95、19.24、9.33,P均＜0.05).观察组患者术后3、6、24、48 h的Ramsay镇静评分均高于对照组,差异均有统计学意义(t分别=2.34、2.02、3.11、2.56,P均＜0.05).观察组患者恶心、呕吐、头晕以及瘙痒的总不良反应发生率明显低于对照组,差异有统计学意义(χ2=5.42,P＜0.05).结论 小剂量艾司氯胺酮复合舒芬太尼术后镇痛能有效降低胸腰椎骨折经皮椎弓根螺钉固定患者的镇痛药物使用次数和用量,对患者术后认知功能影响较小,改善疼痛效果明显,具有较好的镇痛作用,且不良反应发生率更低.
Abstract
Objective To investigate the effect of low-dose esketamine combined with sufentanil on cognitive function in postoperative intravenous analgesia in patients with thoracolumbar fracture after percutaneous pedicle screw internal fixation.Methods A total of 90 patients with thoracolumbar fracture requiring percutaneous pedicle screw internal fixa-tion were selected as the study subjects and divided into two groups by random double-blind method.The control group received sufentanil intravenously,the observation group received intravenous infusion of low dose esketamine combined with sufentanil.The analgesic consumption,postoperative cognitive function,pain score,Ramsay sedation score and the oc-currence of adverse reactions were compared between the two groups.Results The number of effective compressions for controlled intravenous analgesia(PCIA)and the total dosage of sufentanil in PCIA in observation group were significant-ly less than those in control group,with statistical significance(t=18.11,5.95,P＜0.05).The scores of MMSE in observa-tion group at 3,6,24 and 48 hours after operation were significantly higher than those in control group,with statistical significance(t=7.60,4.37,7.51,10.91,P＜0.05).VAS scores at rest and activity at 3,6,24 and 48 hours in the observa-tion group were lower than those in the control group,and the differences were statistically significant(t=12.17,10.69,14.33,12.40,8.74,12.95,19.24,9.33,P＜0.05).Ramsay sedation scores at 3,6,24 and 48hours in observation group were higher than those in control group,and the differences were statistically significant(t=2.34,2.02,3.11,2.56,P＜0.05).The total incidence of nausea,vomiting,dizzi-ness and pruritus in the observation group were sig-nificantly lower than those in the control group,with statistical significance(χ2=5.42,P＜0.05).Conclu-sion Low-dose esketamine combined with sufentanil for postoperative analgesia can effectively reduce the number and dosage of analgesic drugs used in patients with percutaneous pedicle screw fixation of thoracolumbar fracture,which has little effect on postoperative cognitive function of patients,significantly improves pain,has a good analgesic effect and lower incidence of adverse reactions.
维普
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