【摘要】 目的 分析老年股骨颈骨折手术患者围术期多模式联合超前镇痛的应用效果。方法 回顾性分析2019年3月—2020年3月收治的110例老年股骨颈骨折的临床资料，根据镇痛模式的差异分为A组37例、B组33例和C组40例。A组采取超前镇痛，B组采取多模式镇痛，C组采取多模式联合超前镇痛。对比3组术后疼痛视觉模拟评分法(VAS)评分、匹兹堡睡眠质量指数(PSQI)评分、髋关节Harris评分、镇痛次数、追加镇痛剂量、吗啡用量、炎性因子水平，观察各组不良反应发生率。结果 B组术后12、24、48 h的VAS和PSQI评分低于A组，而C组分别低于A组和B组(P<0.05)。B组术后2周和3个月的髋关节Harris评分高于A组，C组分别高于A组和B组(P<0.05)。B组镇痛次数、追加镇痛剂量及术后1、8、24、48 h吗啡用量少于A组，C组分别少于A组和B组(P<0.05)。B组和C组术后24、48 h的白细胞介素-6、白细胞介素-1β和肿瘤坏死因子-α水平低于A组，且C组低于B组(P<0.05)。3组不良反应发生率比较差异无统计学意义(P>0.05)。结论 多模式联合超前镇痛用于老年股骨颈骨折手术的效果优于单纯超前镇痛或多模式镇痛，可减轻术后炎症反应，改善疼痛程度和睡眠质量，促进髋关节功能恢复，安全性高。更多还原

【Abstract】 Objective To analyze the application effect of perioperative multimodal analgesia combined with preemptive analgesia in elderly patients undergoing surgery for femoral neck fracture. Methods The clinical data of 110 elderly patients with femoral neck fractures admitted from March 2019 to March 2020 were retrospectively analyzed. According to the differences in analgesia patterns, they were divided into group A(n=37), group B(n=33) and group C(n=40). Group A received preemptive analgesia, group B received multimodal analgesia, and group C received multimodal analgesia combined with preemptive analgesia. The postoperative visual analogue scale(VAS) pain score, Pittsburgh sleep quality index(PSQI) score, Harris hip score, analgesia frequency, additional analgesic dose, morphine dose, and inflammatory factor levels were compared among the three groups. The incidence of adverse reaction of all groups was observed. Results The VAS and PSQI scores of group B were lower than those of group A at 12, 24, and 48 h after operation, which were lower in group C than in group A and group B respectively(P<0.05). The Harris hip score of group B was higher than that of group A at 2 weeks and 3 months after operation, which was higher in group C than in group A and group B respectively(P<0.05). The frequency of analgesia, the additional analgesic dose and the morphine dose at 1, 8, 24, and 48 h after operation in group B were less than those in group A, which were less in group C than in group A and group B respectively(P<0.05). The levels of interleukin-6, interleukin-1β and tumor necrosis factor-α in groups B and C at 24 and 48 h after operation were lower than those in group A, which were lower in group C than in group B(P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05). Conclusion The effect of multimodal analgesia combined with preemptive analgesia for femoral neck fracture surgery in the elderly is better than that of simple preemptive analgesia or multimodal analgesia. It can reduce postoperative inflammatory response, improve pain and sleep quality, and promote the recovery of hip joint function with high safety.更多还原