预先镇痛在老年骨质疏松椎体压缩性骨折经皮椎体后凸成形术中的应用效果  

Efficacy of preemptive analgesia in percutaneous kyphoplasty for the senile patient with osteoporotic vertebral compressed fracture

作　　者：杨新明[1] 张瑛[1] 贾永利[1] 姚尧 Yang Xinming;Zhang Ying;Jia Yongli;Yao Yao(Department of Orthopaedics,the First Affiliated Hospital of Hebei North University,Zhangjiakou City,Hebei Province 075000,China)

机构地区：[1]河北北方学院附属第一医院骨科,张家口市075000

出　　处：《中华疼痛学杂志》2022年第1期108-115,共8页Chinese Journal Of Painology

基　　金：2018年张家口高层次创新团队建设项目(201804);2021年度河北省卫健委医学科学研究课题(20210570)。

摘　　要：目的评价预先镇痛(PA)在经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)术中的镇痛效果及安全性。方法收集河北北方学院附属第一医院骨科2018年1月至2019年12月行OVCF的老年患者84例,术前腰椎骨密度测定结果为0.485~0.752 g/cm^(2),术前疼痛VAS评分6~9分。按照随机数字表法分为预先镇痛组和未实施预先镇痛组,每组42例。预先镇痛组于手术开始前15 min肌内注射地佐辛10 mg,未实施预先镇痛组于术前不予特殊处理。两组患者均在1%利多卡因局部麻醉下实施PKP。采用视觉模拟评分法(VAS)对两组患者手术开始前(T1)、穿刺套管针穿刺时(T2)、骨水泥推注时(T3)、术后24 h(T4)4个时点的疼痛程度进行评分;记录T1、T2、T3时点患者心率、血压变化情况。对手术开始至术后24 h内药物不良反应、骨水泥外漏及脊髓神经损伤发生情况、患者对术中疼痛控制效果主观满意度以及1%利多卡因使用剂量和手术时间进行比较。结果T1、T2、T3、T4时的VAS评分,预先镇痛组为[(6.9±0.3)、(2.5±0.8)、(2.4±0.6)、(2.2±0.3)]分;未实施预先镇痛组为[(6.8±0.4)、(3.7±0.9)、(3.6±0.6)、(2.4±0.2)]分,两组T2、T3时VAS评分比较差异有统计学意义(P<0.05)。术中1%利多卡因麻醉药使用剂量,预先镇痛组(9.1±1.1)ml明显少于未实施预先镇痛组(18.6±1.4)ml,(P<0.05)。T2、T3时的心率和血压,预先镇痛组分别为[(82±3)和(90±8)]次/min、[(153±3/85±8),(153±6/85±9)]mm Hg明显低于未实施预先镇痛组[(110±5),(121±6)]次/min、[(175±6/99±4),(179±4/105±5)]mm Hg,差异有统计学意义(P<0.05)。自手术开始至术后24 h内,两组间药物不良反应比较差异无统计学意义(P>0.05)。术中患者对镇痛效果的满意度,预先镇痛组明显高于未实施预先镇痛组,差异有统计学意义(P<0.05)。未实施预先镇痛组有2例脊髓神经损伤,多于预先镇痛组,但两组间脊髓神经损伤比较差异Objective To evaluate the analgesic efficacy and safety of preemptive analgesia in percutaneous kyphoplasty for the treatment of senile patient with osteoporotic vertebra compressed fracture.Methods Eighty-four elderly patients with OVCF from January 2018 to December 2019 in the Department of Orthopedics,the First Affiliated Hospital of Hebei North University were collected.Preoperative lumbar vertebral bone density was 0.485 to 0.752 g/cm2,and preoperative VAS was 6 to 9.According to the random number table,the patients were divided into the preemptive group and the non-preemptive group,with 42 patients in each group.The patients were received intramuscular injection of dezocine 10 mg at 15 min before the operation in preemptive group,and no dezocine injection in the non-preemptive group.Patients were given PKP in both groups under local anesthesia with 1%lidocaine.VAS was used to evaluate the pain degree in the two groups at the time before the operation(T1),during trocar puncture(T2),bone cement injection(T3),and 24 h after the operation(T4).The changes of heart rate and blood pressure were recorded at T1,T2 and T3.Adverse drug reactions,bone cement leakage and spinal cord nerve injury were also recorded from the beginning of surgery to 24 h after the surgery.Subjective satisfaction degree with the effect of intraoperative pain control,the dosage of local anesthetic 1%lidocaine and the operation time were also recorded.Results The VAS were[(6.9±0.3),(2.5±0.8),(2.4±0.6)and(2.2±0.3)]at T1,T2,T3 and T4 in the preemptive group,and were[(6.8±0.4,(3.7±0.9),(3.6±0.6)and(2.4±0.2)]in the non-preemptive group respectively.The VAS had significant differences at T2 and T3 between the two groups(P<0.05).The intraoperative dosage of 1%lidocaine was(9.1±1.1)ml in the preemptive group,which was lower than that in the non-preemptive group(18.6±1.4)ml with significant difference(P<0.05).At T2 and T3,the heart rate and blood pressure were[(82±3),(90±8)]beats/min and[(153±3/85±8),(153±6/85±9)]mm Hg in the preempti

关 键 词：骨质疏松性骨折 骨折 压缩性 老年人 疗效 预先镇痛 经皮椎体后凸成形术 

分 类 号：R687.3[医药卫生—骨科学]