吗啡联合右美托咪定在骨填充网袋辅助经皮椎体成形术中的应用  

Application of morphine combined with dexmedetomidine in bone filling mesh container-assisted percutaneous vertebroplasty

作　　者：杨学刚[1] 吴戈[1] 李政文[1] 文华长[1] 孙颜媛[1] 文永均[1] 曹蓉[1] 庞华容[1] 吴辉[1] 许国辉[1] YANG Xuegang;WU Ge;LI Zhengwen;WEN Huachang;SUN Yanyuan;WEN Yongjun;CAO Rong;PANG Huarong;WU Hui;XU Guohui(Department of Interventional Radiology,Sichuan Provincial Caner Hospital,Chengdu,Sichuan Province 610041,China)

机构地区：[1]四川省肿瘤医院介入科,成都610041

出　　处：《介入放射学杂志》2020年第6期604-608,共5页Journal of Interventional Radiology

摘　　要：目的探讨吗啡联合右美托咪定在骨填充网袋辅助经皮椎体成形术(PVP)治疗转移瘤椎体后壁破损性骨折的术中应用的镇痛效果及安全性。方法共纳入121例转移瘤致椎体后壁破损的患者,数字随机表法分为研究组(右美托咪定组)61例和对照组(0.9%NaCl溶液组)60例。两组PVP术前10 min均给予吗啡注射液10 mg皮下注射。研究组PVP术前10 min单次静脉泵入右美托咪定负荷剂量0.6μg·kg^-1·h^-1,10 min后以维持剂量0.4~0.8μg·kg^-1·h^-1至术后3 h结束;对照组以同样方式泵入0.9%NaCl溶液。记录入手术室(T0)、穿刺时(T1)、骨穿针到椎体后1/4时(T2)、骨钻至椎体前1/4处时(T3)、扩张矫形器扩张结束时(T4)、骨水泥注射完(T5)、手术结束(T6)、术后3 h(T7)各时间点的生命体征、镇静评分、镇痛评分的变化。比较两组患者各时间点的镇静评分(改良OAA/S)以及镇痛评分(VAS评分)。结果两组患者各时间点的平均动脉压、心率、呼吸频率、血氧饱和度差异无统计学意义(P>0.05)。两组患者OAA/S评分从T1~T7变化趋势无统计学意义(P>0.05)。研究组的VAS评分从T1~T7均小于对照组,差异有统计学意义(P<0.05)。研究组吗啡追加剂量显著少于对照组(P<0.05)。结论吗啡联合右美托咪定可有效改善骨填充网袋辅助PVP治疗伴椎体后壁破损的椎体转移瘤的术中疼痛,不良反应轻,右美托咪定不会增加不良反应发生率,值得临床推广。Objective To discuss the analgesic effect and safety of morphine combined with dexmedetomidine in bone filling mesh container-assisted percutaneous vertebroplasty(PVP)for fractures of posterior wall of vertebral body due to metastatic tumor.Methods A total of 121 patients with fractures of posterior wall of vertebral body due to metastatic tumor were enrolled in this study.Using digital random table method,the patients were divided into study group(n=61,using dexmedetomidine)and control group(n=60,using normal saline).Subcutaneous injection of 10 mg morphine was given to all patients of both groups 10 min before PVP.For the patients of the study group,10 min before PVP a single intravenous infusion of dexmedetomidine of a loading dose of 0.6μg·kg-1·h-1 was adopted which was followed by a maintenance dose of(0.4-0.8)μg·kg-1·h-1 which lasted until 3h after PVP.For the patients of the control group,infusion of normal saline was carried out in the same way as described above.The time points of observation included entering the operating room(T0),start of puncturing(T1),bone puncture needle reached the posterior 1/4 part of vertebral body(T2),bone drill reached the anterior 1/4 part of vertebral body(T3),at the end of the orthosis dilation(T4),completion of bone cement injection(T5),end of surgery(T6),and at 3 hours after PVP(T7).Ateach time point,the vital signs,sedation score,analgesia score were recorded.The sedation score(based on modified OAA/S)and analgesia score(based on VAS)of each time point were compared between the two groups.Results No statistically significant differences in the mean arterial pressure,heart rate,respiratory frequency and oxygen saturation at each time point existed between the two groups(P>0.05).There was no significant difference in the variation tendency from T1 to T7 of OAA/S score between the two groups(P>0.05).In the study group,all the VAS scores from T1 through T7 were smaller than those in the control group,and the differences were statistically significant(P<0.05).The addit

关 键 词：椎体转移瘤 经皮椎体成形术 骨填充网袋 右美托咪定 疼痛 

分 类 号：R681.5[医药卫生—骨科学]