不同镇痛方式在跟腱缝合修补术后早期应用的临床效果分析  

Analysis of the Clinical Effect of Different Analgesia Methods in Early Stage After Achilles Tendon Suture Repair

作　　者：张竹 陶立元[2] 刘文静 李楠[4] 许莹莹[1] 杨渝平[1] Zhang Zhu;Tao Liyuan;Liu Wenjing(Department of Sports Medicine,Peking University Third Hospital,Beijing 100191,China;不详)

机构地区：[1]北京大学第三医院运动医学科,北京100191 [2]北京大学第三医院体检中心,北京100191 [3]北京大学护理学院,北京100191 [4]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《中国微创外科杂志》2022年第12期971-974,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的观察跟腱断裂缝合修补术后早期不同镇痛模式的效果。方法回顾性分析2015年5月~2018年7月同一组医师进行的腰麻下急性闭合性跟腱断裂缝合修补术90例资料,根据患者实际接受术后镇痛情况分为3组各30例,提前镇痛组术后即刻口服盐酸曲马多缓释片100 mg提前镇痛,肌注镇痛组主诉疼痛时肌内注射盐酸哌替啶注射液1 mg/kg+盐酸异丙嗪注射液25 mg,口服镇痛组主诉疼痛时口服盐酸曲马多缓释片100 mg。3组性别、年龄、体重指数、受伤至入院时间、MRI测量的跟腱远侧断端距跟骨结节的距离差异无统计学意义(P>0.05)。比较3组术后0、4、6、12 h疼痛数字评分(Numeric Rating Scale,NRS)。结果术后0 h时3组疼痛NRS评分均为0分,术后4 h时提前镇痛组得分最低0.23±0.43(P=0.000),6 h时3组间差异无统计学意义(P=0.137),12 h时肌注镇痛组得分最低3.13±1.46(P=0.007)。0~12 h疼痛NRS评分曲线下面积提前镇痛组最小22.43±6.06,其次是肌注镇痛组27.90±8.46,最大的是口服镇痛组30.70±11.61(P=0.002)。在不良反应方面,仅肌注镇痛组呕吐1例。结论对于跟腱缝合修补术后早期的患者,应用盐酸曲马多缓释片提前镇痛的镇痛效果最优。Objective To observe the effect of different analgesia modes in early stage after repair of Achilles tendon rupture.Methods A retrospective analysis was made on 90 cases of repair of acute closed Achilles tendon rupture under lumbar anesthesia performed by the same group of surgeons from May 2015 to July 2018.According to the actual situation of patients receiving postoperative analgesia,they were divided into three groups with 30 cases in each group.In the early analgesia group,100 mg tramadol hydrochloride sustained-release tablets were taken immediately for early analgesia after surgery.In the intramuscular analgesia group,1 mg/kg of pethidine hydrochloride and 25 mg of promethazine hydrochloride were injected intramuscularly when complaining of pain.In the oral analgesia group,100 mg tramadol hydrochloride sustained-release tablets were taken when complaining of pain.There were no significant differences in gender,age,body mass index,injury time(from injury to hospital admission),and the distance from the distal end of Achilles tendon to the calcaneal tubercle measured by MRI among the three groups(P>0.05).The numerical rating scale(NRS)at 0,4,6,and 12 h after operation was compared among the three groups.Results The NRS scores of the three groups were 0 at 0 h after operation.At 4 h after operation,the lowest score was 0.23±0.43 in the early analgesia group(P=0.000).There was no significant difference among the three groups at 6 h(P=0.137).At 12 h after operation,the lowest score was 3.13±1.46 in the intramuscular analgesia group(P=0.007).The minimum area under the NRS curve of 0-12 h was in the early analgesia group(22.43±6.06),followed by the intramuscular analgesia group(27.90±8.46),and the oral analgesia group(30.70±11.61)(P=0.002).In terms of adverse reactions,only one patient vomited in the intramuscular analgesia group.Conclusion Tramadol hydrochloride sustained-release tablets have the best analgesic effect for early postoperative patients after Achilles tendon suture repair.

关 键 词：跟腱修复术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]