术中局部应用镇痛药对股骨头坏死术后镇痛的影响  

Effect of local application of mixed analgesics drugs on the postoperative analgesia in patients with necrosis of femoral head

作　　者：谢辉[1] 曹孟 王本杰[1] 傅维民[1] 赵德伟[1] XIE Hui;CAO Meng;WANG Ben-Jie;FU Wei-Min;ZHAO De-Wei(Department of orthopaedics,Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院骨科,大连116001

出　　处：《中国疼痛医学杂志》2021年第3期202-207,共6页Chinese Journal of Pain Medicine

基　　金：国家十三五“国家重点研发计划”项目(2016YFC1102000);中国博士后科学基金项目(2020M670715)。

摘　　要：目的:探讨术中局部应用混合镇痛药物对股骨头坏死行“带血管蒂髂骨瓣转移术”后的镇痛疗效。方法:选取2017年1月至2018年10月在大连大学附属中山医院骨科行“带血管髂蒂骨瓣转移术”的股骨头坏死病人50例,年龄为18~40岁,根据随机数字表法分为注射组26例,术中髋周使用混合镇痛药物行局部浸润麻醉,混合镇痛药物(包括吗啡10 mg、罗哌卡因268.2 mg、曲安奈德50 mg、头孢替唑钠1 g,加生理盐水至100 ml)和对照组24例,术中注射等量生理盐水,随访72 h,采用视觉模拟评分法(visual analogue scale,VAS)评估病人术后6 h、12 h、24 h、48 h、72 h静息疼痛和对疼痛满意度的评分,以及术后出现的不良反应。结果:与对照组相比,注射组术后6 h、12 h、24 h、48 h静息状态疼痛VAS评分明显降低(P<0.05);两组病人对术后疼痛满意度的VAS评分在术后6 h内注射组明显高于对照组(P<0.05),在术后12~72 h内的评分无明显差异(P>0.05);注射组术后阿片类药物消耗总量明显减少(P<0.05);且注射组有较低的术后并发症。结论:在股骨头坏死保髋术中局部应用混合镇痛药物具有操作简单,减少阿片类药物消耗量及并发症的优点,有利于术后快速康复。Objective:To explore the analgesic effect of local application of mixed analgesics in the treatment of osteonecrosis of the femoral head.Methods:A randomized controlled study enrolled 50 cases of femoral head necrosis that underwent vascularized iliac pedicle bone flap transfer from January 2017 to October 2018 in the bone and joint center of Zhongshan Hospital affiliated to Dalian University.Their ages ranged from 18 to 40 years.They were randomly divided into injection group(26 cases)and control group(24 cases).Contrastive evaluation:general data of patients were recorded;resting pain and VAS score of patients'satisfaction at 6,12,24,48 and 72 h after operation were recorded as well as the adverse reactions after operation.Results:There was no statistical difference in general data between the two groups.Compared with the control group,the VAS score of resting state pain in the injection group decreased significantly at 6,12,24 and 48 h after operation(P<0.05),the VAS score of patients'satisfaction with resting pain in the injection group was significantly higher than that in the control group within 6 h after operation(P<0.05),the scores within 12 to 72 h after operation were similar(P>0.05),the total consumption of opioids in the injection group decreased significantly(P<0.05)and the injection group had less postoperative complications compared with the control group.Conclusion:Local application of mixed analgesics drugs during operation has the advantage in simple operation under direct vision,and has better early analgesic effect on the basis of reducing the consumption of opioids and complications in the vascular pedicled iliac bone flap transfer for necrosis of femoral head.

关 键 词：混合镇痛药物 局部浸润麻醉 带血管蒂髂骨瓣转移术 股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学]