不同镇痛药物方案治疗下肢缺血性疼痛的疗效和安全性分析  

Efficacy and safety of different analgesia drugs in the treatment of lower extremity ischemic pain

作　　者：李谈[1] 张杨[1] 张望德[1] 王云[2] LI Tan;ZHANG Yang;ZHANG Wangde;WANG Yun(Department of Vascular Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Anesthesiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020 [2]首都医科大学附属北京朝阳医院手麻科,北京100020

出　　处：《中国药物警戒》2023年第6期680-683,共4页Chinese Journal of Pharmacovigilance

基　　金：国家自然科学基金资助项目(82171217)。

摘　　要：目的对下肢缺血性疼痛患者不同镇痛药物方案的应用情况进行分析,对临床用药提供参考。方法选取2018年10月1日至2022年10月31日下肢缺血性疼痛住院患者作为研究对象,采用回顾分析法对患者镇痛药物方案进行分析,收集患者基本情况、镇痛药物使用情况、疼痛视觉模拟量表(VAS)评分、不良反应等进行分析。结果共入组患者71例,按照镇痛方案分阿片类药物组30例、阿片类药物+非甾体抗炎药组(NSAIDs)32例和坐骨神经阻滞组9例。3组患者性别、年龄、病程、合并疾病及吸烟史的比较,差异无统计学意义(P>0.05);坐骨神经阻滞组VAS评分下降值和阿片类药物组、阿片类药物联合NSAIDs组比较,差异有统计学意义(分别为6.667±1.658 vs 3.567±0.817,t=7.716,P<0.001;6.667±1.658 vs 3.938±0.982,t=6.271,P<0.001)。阿片类药物组和阿片类药物联合NSAIDs组比较,差异无统计学意义(P>0.05)。3组不良反应和安全性比较,差异无统计学意义(P>0.05)。结论下肢缺血性疼痛镇痛药物方案有多种模式,相对于单用阿片类药物或阿片类药物联用NSAIDs,坐骨神经阻滞的应用在患者疼痛主诉和VAS评分下降改善明显,不良反应较少,值得临床应用推广。Objective To analyze the applicability of different analgesic schemes in patients with ischemic pain of lower limbs,and to provide reference for clinical medication.Methods Patients with ischemic pain of lower limbs treated between October 1,2018 and October 31,2022 were selected as the subjects.The analgesic schemes were evaluated via retrospective analysis.The basic data of patients,usage of analgesic drugs,scores of the visual analogue scale(VAS)of pain and incidence of adverse reaction were analyzed.Results The 71 patients were divided into the opioid group(30 cases),opioid plus non-steroidal anti-inflammatory drugs(NSAIDs)group(32 cases)and sciatic nerve block group(9 cases).There was no significant difference in gender,age,courses of disease,disease complications or smoking status between the three groups(P>0.05).The VAS score decreased more significantly in the sciatic nerve block group than in the opioid group and opioid combined with NSAIDs group(6.667±1.658 vs 3.567±0.817,t=7.716,P<0.001;6.667±1.658 vs 3.938±0.982,t=6.271,P<0.001),but there was no significant difference between the opioid group and the opioid combined with NSAIDs group(P>0.05)or between the three groups(P>0.05)in terms of adverse reactions and safety.Conclusion There are many analgesic regimens for ischemic pain in lower limbs.Compared with opioid alone or opioid combined with NSAIDs,sciatic nerve block can improve pain complaints and VAS scores more significantly and cause fewer adverse reactions,which should be made more accessible.

关 键 词：下肢缺血性疼痛 镇痛药物 阿片类药物 非甾体抗炎药 坐骨神经阻滞 疗效 不良反应 安全性 

分 类 号：R994.11[医药卫生—毒理学]