地塞米松静脉给药对胸椎旁神经阻滞后反跳痛控制效果的随机对照研究  

Randomized Controlled Study on the Effect of Intravenous Administration of Dexamethasone on the Control of Rebound Tenderness after Thoracic Paravertebral Block

作　　者：李明 LI Ming(Department of Anaesthesia,the First People's Hospital of Fuzhou,Fuzhou 344000,China)

机构地区：[1]抚州市第一人民医院麻醉科,江西抚州344000

出　　处：《中国医学创新》2025年第12期140-143,共4页Medical Innovation of China

摘　　要：目的:评估静脉给予地塞米松预防胸椎旁神经阻滞(TPVB)后反跳痛的临床效果。方法:选取2021年9月—2024年6月在抚州市第一人民医院择期行多发性肋骨骨折切开复位内固定术的102例患者为研究对象,以随机数字表法分为T组(n=51,行TPVB)和TD组(n=51,TPVB后静脉注射地塞米松)。对比两组反跳痛发生率、静息数字分级评分法(NRS)评分、术后镇痛情况、不良反应发生情况。结果:TD组反跳痛发生率为21.57%(11/51),显著低于T组的45.10%(23/51),差异有统计学意义(χ^(2)=6.353,P=0.012)。两组术前及术后6、12 h静息NRS评分比较,差异均无统计学意义(P>0.05);术后24、48 h,TD组的静息NRS评分均低于T组,差异均有统计学意义(P<0.05)。两组PCIA首次按压时间比较,差异无统计学意义(P>0.05);TD组术后48 h PCIA总按压次数明显少于T组,曲马多补救镇痛率明显低于T组(P<0.05)。两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论:静脉注射地塞米松能有效减少TPVB后反跳痛发生,减轻疼痛程度,并减少补救镇痛需求。Objective:To evaluate the clinical effect of intravenous administration of Dexamethasone in preventing rebound tenderness after thoracic paravertebral block(TPVB).Method:A total of 102 patients who underwent open reduction and internal fixation for multiple rib fractures in the First People's Hospital of Fuzhou from September 2021 to June 2024 were selected as the study objects,and they were divided into T group(n=51,received TPVB)and TD group(n=51,received intravenous administration of Dexamethasone after TPVB)by random number table method.The incidence of rebound tenderness,resting numerical rating scale(NRS)score,postoperative analgesia and adverse reactions were compared between the two groups.Result:The incidence of rebound tenderness in TD group was 21.57%(11/51),which was significantly lower than 45.10%(23/51)in T group,the difference was statistically significant(χ^(2)=6.353,P=0.012).There were no significant differences in resting NRS scores between the two groups before surgery and 6,12 h after surgery(P>0.05).24,48 h after surgery,the resting NRS scores in TD group were lower than those in T group,the differences were statistically significant(P<0.05).There was no significant difference in the first compression time of PCIA between the two groups(P>0.05).The total number of PCIA compressions within 48 h after surgery in TD group was significantly lower than that in T group,and the remedial analgesia rate of Tramadol was significantly lower than that in T group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Intravenous administration of Dexamethasone can effectively reduce the occurrence of rebound tenderness after TPVB,reduce the degree of pain,and reduce the need for remedial analgesia.

关 键 词：地塞米松 胸椎旁神经阻滞 反跳痛 肋骨骨折 

分 类 号：R614[医药卫生—麻醉学]