曾建峰++黄志思+刘江梅+胡兆云+唐超

[摘要]目的 觀察氟比洛芬脂联合侧隐窝阻滞在老年患者下肢骨科手术超前镇痛中的应用效果。方法 选取2016年1～12月在我院择期行下肢骨科手术的老年患者60例为研究对象，采用随机数字表法分成A、B、C组，每组20例。A组采用氟比洛芬脂+侧隐窝阻滞作为联合超前镇痛；B组采用侧隐窝阻滞并术后连续侧隐窝镇痛；C组采用单纯连续硬膜外阻滞。观察三组侧隐窝阻滞和硬膜外阻滞穿刺成功率和穿刺时间，术后VAS疼痛评分及住院天数和住院费用等。结果 A组术后1、4、16、24、48 h的VAS评分均明显低于B、C组，差异有统计学意义（P<0.05），B组各时间VAS评分低于C组，但差异无统计学意义（P>0.05）；A组穿刺成功率为95.0%，明显高于B、C组的85.0%、80.0%，穿刺时间也较B、C组明显缩短，差异均有统计学意义（P<0.05）；A组住院时间、住院费用均较B组和C组明显缩短和减少，差异有统计学意义（P<0.05）。结论 临床中针对老年患者下肢骨科手术中采用氟比洛芬脂联合侧隐窝阻滞超前镇痛，操作简便，安全有效，穿刺成功率高，并发症少，具有推广意义。

[关键词]氟比洛芬脂；侧隐窝阻滞；下肢骨科手术；超前镇痛

[中图分类号] R614.2+4 [文献标识码] A [文章编号] 1674-4721（2017）05（b）-0100-03

Application of Flurbiprofen Axetil combined with lateral recess block in preemptive analgesia in elderly patients undergoing the orthopedics operation of lower limb

ZENG Jian-feng1 HUANG Zhi-si2 LIU Jiang-mei3 HU Zhao-yun1 TANG Chao3

1.Department of Anesthesia，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China；2.Operating Room，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China；3.Department of Orthopedics and Traumatology，Chinese Medicine Hospital of Huiyang District in Huizhou City of Guangdong Province，Huizhou 516211，China

[Abstract]Objective To observe the application effect of Flurbiprofen Axetil combined with lateral recess block in preemptive analgesia in elderly patients undergoing the orthopedics operation of lower limb.Methods 60 elderly patients scheduled for lower extremity orthopedic surgery from Janurary to December 2016 in our hospital were selected and they were divided into group A，B and C by random number table，and there were 20 cases in each group.Group A was given Flurbiprofen Axetil combined with lateral recess block for preemptive analgesia.Group B was given lateral recessive obstruction and postoperative continuous lateral recess analgesia.Group C was given simple continuous epidural block.The success rate of puncture for lateral recessive obstruction and continuous epidural block，and puncture time，postoperative VAS pain score，hospital stay and hospitalization cost and so on were observed.Results The VAS score of group A were significantly lower than those of group B and group C at 1，4，16，24，48 h after operation （P<0.05）.The VAS score of group B was lower than that of group C，but the difference was not statistically （P>0.05）.The success rate of group A was 95.0%，which was significantly higher than that of group B and group C （85.0% and 80.0%），and the time of puncture was shorter than that of group B and C，the difference was statistically significant （P<0.05）.The time of hospitalization and hospitalization in group A were significantly shorter than those in group B and group C，the difference was statistically significant （P<0.05）.Conclusion The clinical application of Flurbiprofen Axetil combined with lateral recessive obstruction in elderly patients with orthopedic surgery is simple，safe and effective.The success rate of puncture is high and the complication is less.

[Key words]Flurbiprofen Axetil；Lateral recess obstruction；Orthopedics operation of lower limb；Preemptive analgesia

随着我国人均寿命的显著增长，老年骨科患者也在增加，其中下肢骨科手术患者术后手术部位疼痛剧烈，活动时尤为严重，疼痛高峰期主要集中在术后3 d内，不仅影响全身情况的恢复，严重并发症增多，而且患者因疼痛而惧怕功能锻炼，增加术后肺部并发症的发生及术后下肢血栓的发生，影响术后的康复[1-2]，因此，充分镇痛是下肢骨科手术术后快速康复的核心与关键，只有充分镇痛，术后的早期康复训练才能得以保证，目前镇痛主要有静脉注射或口服阿片类等药物或者硬膜外置管持续给药镇痛，但是因其各有相关并发症或效果欠佳，饱受争议[3-4]，因此，寻找合适理想镇痛方式是麻醉界一直探索的问题。……