药学实践推动PCIA方案优化：髋关节置换术后阿片类联用与单用方案的疗效与安全性比较

Pharmacy Practice Promotes PCIA Protocol Optimization: A Comparative Study On The Efficacy And Safety Of Opioid Combination Versus Single-Agent Regimens After Hip Arthroplasty

关键词:  髋关节置换术  患者自控静脉镇痛  阿片类药物  多因素分析  术后疼痛  术后恶心呕吐

Key words:  hip arthroplasty  patient-controlled intravenous analgesia  opioids  multivariate analysis  postoperative pain  postoperative nausea and vomiting

摘要:

目的 比较髋关节置换术（HA）后患者自控静脉镇痛（PCIA）中阿片类药物联用与单用方案对术后早期疼痛及不良反应的实效影响。方法 采用回顾性队列研究，连续纳入2021年3月至6月及2025年3月至6月行单侧HA并使用PCIA的患者195例，根据PCIA配方分为联用组（n=86）和单用组（n=109）。收集包括人口学、术前疼痛、手术麻醉记录等变量。主要结局为术后（第0天、1天、2天）静息疼痛VAS评分，次要结局为术后恶心呕吐（PONV）及谵妄发生率。采用多因素回归分析，通过构建未调整、部分调整及完全调整模型，分析不同组别与结局的关联。结果 单因素分析显示，联用组术后各时间点疼痛VAS评分均低于单用组（P均<0.001）。在调整术前疼痛、手术时长、麻醉用药等因素后，多因素分析表明，两组在术后疼痛评分（术后当天：β= -0.32， P=0.123；术后第1天：β= -0.18， P=0.378；术后第2天：β= -0.21， P=0.236）及PONV风险（OR=1.39， P=0.833）上均无统计学差异。术后谵妄发生率组间亦无差异。结论 HA术后PCIA采用阿片类药物联合或单用方案，在术后早期镇痛效果与安全性方面未见显著差异。研究支持在规范的多模式镇痛管理下，采用单用阿片类药物的PCIA方案可作为合理的临床选择。

Abstract:

OBJECTIVE To compare the real-world effects of opioid combination regimens versus single-agent regimens in patient-controlled intravenous analgesia (PCIA) on early postoperative pain and adverse reactions in patients after hip arthroplasty (HA). METHODS A retrospective cohort study was conducted, continuously enrolling 195 patients who underwent unilateral HA and received PCIA from March to June 2021 and from March to June 2025. Based on the PCIA formula, patients were divided into a combination group (n=86) and a single-agent group (n=109). Variables including demographics, preoperative pain, and surgical/anesthesia records were collected. The primary outcomes were resting pain visual analogue scale (VAS) scores on postoperative days 0, 1, and 2. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV) and delirium. Multivariate regression analysis was performed by constructing unadjusted, partially adjusted, and fully adjusted models to analyze the association between groups and outcomes. RESULTS Univariate analysis showed that the combination group had lower VAS pain scores at all postoperative time points compared to the single-agent group (all P < 0.001). After adjusting for confounding factors such as preoperative pain, surgery duration, and anesthesia medications, multivariate analysis indicated no statistically significant differences between the two groups in postoperative pain scores (postoperative day 0: β = -0.32, P = 0.123; postoperative day 1: β = -0.18, P = 0.378; postoperative day 2: β = -0.21, P = 0.236) or PONV risk (OR = 1.39, P = 0.833). There was also no significant difference in the incidence of postoperative delirium between the groups. CONCLUSION For HA patients receiving PCIA, no significant differences were observed in early postoperative analgesic efficacy or safety between opioid combination and single-agent regimens. This study supports that a single-opioid PCIA regimen, under standardized multimodal analgesia management, can be a reasonable clinical option.