酮咯酸氨丁三醇联合地塞米松在全膝关节置换术后镇痛中的应用效果观察  

Effect of Ketorolac Tromethamine Combined with Dexamethasone on Analgesia after Total Knee Arthroplasty

作　　者：李二毛 LI Ermao(Jiyuan People's Hospital,Jiyuan Henan 459003,China.)

机构地区：[1]济源市人民医院,河南济源459003

出　　处：《药品评价》2024年第12期1475-1479,共5页Drug Evaluation

摘　　要：目的观察酮咯酸氨丁三醇联合地塞米松在全膝关节置换术后镇痛中的应用效果。方法前瞻性选择2022年1月至2023年6月济源市人民医院收治住院并拟行全膝关节置换术患者100例,根据入院顺序分为观察组和对照组,每组各50例。对照组在手术结束前30 min给予酮咯酸氨丁三醇注射液30 mg,观察组在对照组基础上,术前30 min给予地塞米松10 mg,术后即刻再次静脉滴注地塞米松10 mg,两组术后自控静脉镇痛泵均采用同一方案,持续48 h。记录术后恢复情况、疼痛程度、睡眠质量,术前和术后12 h、24 h、48 h患侧膝关节活动度(ROM),术前和术后24 h血清炎性因子水平,术后24 h内补救性阿片类药物使用情况和术后48 h内不良反应发生情况。结果观察组苏醒时间、术后首次下地时间、术后排气时间均短于对照组,术后24 h和48 h内镇痛泵按压次数小于对照组(P<0.05);术后2 h、4 h、8 h、24 h、48 h时,观察组静息状态和活动状态下视觉模拟评分低于对照组(P<0.05);术后12 h、24 h、48 h时,观察组膝关节ROM大于对照组(P<0.05);术后24 h时,观察组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、超敏C反应蛋白(hs-CRP)水平低于对照组(P<0.05);术后24 h、48 h时,观察组匹兹堡睡眠质量指数(PSQI)评分低于对照组(P<0.05);观察组术后24 h内补救性阿片类药物使用率低于对照组(P<0.05);观察组恶心呕吐发生率低于对照组(P<0.05)。结论酮咯酸氨丁三醇联合地塞米松可提高全膝关节置换术后镇痛效果,减少镇痛泵按压次数,降低术后24 h内补救性阿片类药物使用率,预防术后恶心呕吐,促进膝关节功能恢复,改善睡眠质量,具有临床应用价值。Objective To observe the effect of ketorolac tromethamine combined with dexamethasone in analgesia after total knee arthroplasty.Methods A total of 100 patients who were admitted to Jiyuan People's Hospital and planned to undergo total knee arthroplasty from January 2022 to June 2023 were prospectively selected and divided into observation group and control group according to the admission order,with 50 patients in each group.The control group was given 30 mg of ketorolac tromethamine injection 30 minutes before the end of the surgery,while the observation group was given 10 mg of dexamethasone 30 minutes before surgery on the basis of the control group,immediately after surgery,10 mg of dexamethasone was intravenously administered again.Record the postoperative recovery,pain level and sleep quality,the range of motion(ROM)of the affected knee joint before surgery and 12,24 and 48 hours after surgery;the serum levels of inflammatory factors before and 24 h after surgery;the use of remedial opioid drugs within 24 h after surgery and the occurrence of adverse reactions within 48 hours after surgery.Results The recovery time,the first time to go to the ground after surgery,and the postoperative exhaust time in the observation group were shorter than those in the control group,and the number of analgesic pump compression in 24 h and 48 h after surgery were shorter than those in the control group(P<0.05).At 2 h,4 h,8 h,24 h and 48 h after surgery,the visual analog scale of resting state and active state in the observation group were lower than those in the control group(P<0.05).At 12 h,24 h and 48 h after operation,the knee ROM in observation group were higher than those in control group(P<0.05).At 24 h after operation,the serum levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and hypersensitive C-reactive protein(hs-CRP)in observation group were lower than those in control group(P<0.05).The Pittsburgh sleep quality index(PSQI)of the observation group was lower than that of the control group at 24 h a

关 键 词：全膝关节置换术 酮咯酸氨丁三醇 地塞米松 术后镇痛 恶心呕吐 膝关节功能 睡眠质量 

分 类 号：R687.4[医药卫生—骨科学]