[1]陈明,曹奇圣,王力,等.加速康复外科理念下多模式镇痛在老年股骨转子间骨折治疗中的应用[J].中华老年骨科与康复电子杂志,2019,(01):4-8.[doi:10.3877/cma.j.issn.2096-0263.2019.01.002]
　Chen Ming,Cao Qisheng,Wang Li,et al.Application of multi-mode analgesia in the treatment of aged femoral intertrochanteric fracture under the enhanced recovery after surgery (ERAS)[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(01):4-8.[doi:10.3877/cma.j.issn.2096-0263.2019.01.002]
点击复制

加速康复外科理念下多模式镇痛在老年股骨转子间骨折治疗中的应用()
分享到：

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年01期
页码:
4-8
栏目:
髋部骨折
出版日期:
2019-02-05

文章信息/Info

Title:
Application of multi-mode analgesia in the treatment of aged femoral intertrochanteric fracture under the enhanced recovery after surgery (ERAS)
作者:
陈明1; 曹奇圣2; 王力2; 吴珍珍1
330006 南昌大学第一附属医院骨科1；330006 南昌，江西中医药大学附属医院骨科2
Author(s):
Chen Ming1;  Cao Qisheng2;  Wang Li2;  Wu Zhenzhen1
1Department of Orthopadics, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China; 2Department of Orthopadics, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
关键词:
围手术期;  镇痛;  老年人;  髋骨折;  加速康复外科
Keywords:
Perioperative period;  Analgesis;  Aged;  Hip fractures;  Enhanced recovery after ; surgery
DOI:
10.3877/cma.j.issn.2096-0263.2019.01.002
文献标志码:
A
摘要:
目的 探讨加速康复外科理念下，围术期多模式镇痛在老年股骨转子间骨折治疗中的应用。方法 回顾性分析2016年6月至2017年6月南昌大学第一附属医院骨科采用PFNA手术治疗的45例老年（≥80岁）股骨转子间骨折患者，其中男性19例（42.2%），女性26例（57.8%），平均年龄为（81.3±1.0）岁。所有患者均在骨折后48 h内采取闭合复位PFNA内固定手术，并采取多模式镇痛方案进行干预，采用简式McGill疼痛问卷和Harris髋关节功能评分标准来观察患者疼痛缓解、髋关节功能恢复的情况。结果 所有患者均获得满意随访，随访率100%，随访时间为3～14个月，平均（9.0±2.0）个月。末次随访时，简式McGill疼痛问卷结果：无痛39例，轻度6例，中度0例，重度0例，无痛率约达86.67%；Harris髋关节功能评分结果：优25例，良13例，可7例，差0例，优良率约达84.44%。结论 围术期多模式镇痛应用于老年股骨转子间骨折患者的治疗中，有利于减少因骨折后疼痛带来的一系列负面影响，加快术后康复进程。
Abstract:
Objective To explore the application of perioperative multimodal analgesia in the treatment of intertrochanteric fractures in the elderly under the guidance of the concept of accelerated rehabilitation surgery. Methods A retrospective study of 45 elderly (≥80 years old) femoral intertrochanteric fractures who underwent PFNA surgery in our department from June 2016 to June 2017.There were 19 males (42.2%) and 26 females (57.8%) with an average age of (81.3±1.0) years. All patients underwent closed reduction PFNA within 48 h after fracture. Internal fixation was performed and a multimodal analgesia protocol was used to intervene. The Jane McGill pain questionnaire and the Harris hip function score were used to observe pain relief and hip function recovery. Results All patients were evaluated by the simple McGill Pain Questionnaire and the Harris Hip Function Score. Patients were followed up for 3-14 months with an average of (9.0±2.0) months. The final follow-up showed 39 cases of painless of the simple McGill pain questionnaire, 6 cases of mild pain, 0 case of moderate, 0 case of severe, the rate of painlessness was about 86.67%. Harris hip function score were excellent in 25 cases, 13 cases were good, 7 cases were fair, and 0 case were poor. The excellent and good rate was about 84.44%. Conclusion Perioperative multi-mode analgesia applied to the elderly patients with intertrochanteric fractures is beneficial to reduce the negative effects of traumatic stress caused by post-fracture pain and accelerate the postoperative recovery process.

参考文献/References:

1 中华医学会外科学分会. 中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南 [J]. 中国实用外科杂志, 2018, 38(1): 1-20.
2 中华医学会麻醉学分会. 成人术后疼痛处理专家共识 [J]. 临床麻醉学杂志, 2010, 26(3): 190-196.
3 史冬立, 贺宇, 毕丛丛, 等. 疼痛管理在老年骨折快速康复护理中的应用现状 [J]. 中华老年骨科与康复电子杂志, 2017, 3(5): 314-316.
4 Yang R, Tao W, Chen YY, et al. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis [J]. Int J Surg, 2016, 36(Pt A): 274-282.
5 Wong-Lun-Hing EM, van Woerden V, Lodewick TM, et al. Abandoning prophylactic abdominal drainage after hepatic surgery: 10 years of no-drain policy in an Enhanced Recovery after Surgery environment [J]. Dig Surg, 2017, 34(5): 411-420.
6 Feldheiser A, Aziz O, Baldini G, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice [J]. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
7 Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial [J]. Ann Surg, 2003, 238(5): 641-648.
8 张少云, 黄强, 曹国瑞, 等. 加速康复外科模式下全膝关节置换术围术期限制性输液的临床研究 [J]. 中国矫形外科杂志, 2017, 25(17): 1567-1571.
9 杨尹默. 加速康复外科临床实践中应重视的几个问题 [J]. 中国实用外科杂志, 2018, 38(1): 34-36.
10 中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016) [J]. 中华外科杂志, 2016, 54(6): 413-418.
11 徐建国. 疼痛药物治疗学 [M] . 北京: 人民卫生出版社, 2007 .
12 冷希圣, 韦军民, 刘连新, 等. 普通外科围手术期疼痛处理专家共识(2015) [J]. 中华普通外科杂志, 2015, 30(2): 166-173.
13 张英泽. 不同历史阶段老年骨科治疗方式的回顾与展望 [J]. 中华老年骨科与康复电子杂志, 2018, 4(1): 1-3.
14 常志泳, 包倪荣, 赵建宁, 等. 加速康复外科理论在高龄股骨颈骨折围手术期的初步应用 [J]. 中国矫形外科杂志, 2013, 4(2): 123-126.
15 钟俊青, 王连成. 快速外科通道理念对老年股骨转子间骨折围手术期康复指导的前瞻性研究 [J]. 中华老年骨科与康复电子杂志, 2016, 2(2): 87-91.
16 常伟, 徐晨阳, 顾强荣, 等. 加速康复外科理念在长寿老人髋部骨折围手术期治疗中的应用 [J]. 实用老年医学, 2017, 31(12): 1110-1113.
17 江志伟, 黎介寿. 规范化开展加速康复外科几个关键问题 [J]. 中国实用外科杂志, 2016, 36(1): 44-46.
18 江志伟, 李宁, 黎介寿. 快速康复外科的概念及临床意义 [J]. 中国实用外科杂志, 2007, 27(2): 131-133.
19 Lovich-Sapola J, Smith CE, Brandt CP. Postoperative pain control [J]. Surg Clin North Am, 2015, 95(2): 301-318.

相似文献/References:

[1]李玉龙,翁习生,董玉雷.老年全膝关节置换术围手术期并发症影响因素的研究进展[J].中华老年骨科与康复电子杂志,2016,(03):177.[doi:10.3877/cma.j.issn.2096-0263.2016.03.010]
　Li Yulong,Weng Xisheng,Dong Yulei.Research progress of influence factors concerning perioperative complications of total knee arthroplasty in aged patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):177.[doi:10.3877/cma.j.issn.2096-0263.2016.03.010]
[2]刘烨,解雅英.老年骨科患者术后镇痛研究现状及新进展[J].中华老年骨科与康复电子杂志,2019,(01):58.[doi:10.3877/cma.j.issn.2096-0263.2019.01.011]
　Liu Ye,Xie Yaying.Research status and new progress of postoperative analgesia in elderly orthopedic patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(01):58.[doi:10.3877/cma.j.issn.2096-0263.2019.01.011]

备注/Memo

备注/Memo:
基金项目：江西省教育厅课题（GJJ170051）
更新日期/Last Update: 2019-02-25