计划性镇痛方案可改善髋部骨折手术后的康复。
Scheduled analgesic regimen improves rehabilitation after hip fracture surgery.
机构信息
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
出版信息
Clin Orthop Relat Res. 2013 Jul;471(7):2349-60. doi: 10.1007/s11999-013-2927-5. Epub 2013 Mar 30.
BACKGROUND
Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery.
QUESTIONS/PURPOSES: We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points.
METHODS
We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols.
RESULTS
As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk.
CONCLUSIONS
The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery.
LEVEL OF EVIDENCE
Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
背景
髋部骨折手术后，患者的康复常受到术后疼痛的限制。
问题/目的：我们比较了髋部骨折手术后患者使用计划镇痛剂量与按需镇痛剂量的方法，比较了这两种方法在以下方面的差异：（1）静息和动态疼痛强度；（2）术后患者的活动能力；（3）功能终点。
方法
我们对在我院接受手术治疗的 400 例髋部骨折患者进行了前瞻性队列研究。两组患者按序分组，前 200 例患者为干预组（术后前 3 周接受计划镇痛治疗），后 200 例患者为对照组（使用按需镇痛方案治疗）。比较了两种镇痛方案之间的静息和动态疼痛强度、活动能力和功能表现。
结果
与预期一致，对照组的镇痛药消耗量较低（曲马多剂量分别为 27 与 63；扑热息痛剂量分别为 29 与 63）。尽管两组镇痛药消耗量差异较大，但每组的静息和动态疼痛强度均有所改善，且两组间术后疼痛无差异。然而，对照组的功能结局与镇痛药消耗量呈正相关。干预组出院时的功能表现更高（老年移动量表分别为 11 与 8；功能独立性量表分别为 88 与 79）。出院时，干预组更少的患者需要轮椅助行（分别为 3 与 32），意味着更多的患者能够行走。
结论
该研究表明，计划镇痛摄入可以改善老年髋部骨折患者手术后的功能结局。
证据水平
Ⅱ级，治疗性研究。欲了解完整的证据水平描述，请参见作者指南。
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