摘要
目的观察酮咯酸氨丁三醇联合盐酸纳布啡静脉自控镇痛在下肢骨折切开复位内固定术后的镇痛效果及对血清疼痛介质的影响。方法回顾性抽取2022年6月至2023年6月于南阳市第一人民医院行下肢骨折切开复位内固定手术患者73例,按术后镇痛方案分为对照组(36例)与观察组(37例)。两组均行全身麻醉,对照组采用盐酸纳布啡静脉自控镇痛,观察组采用酮咯酸氨丁三醇联合盐酸纳布啡静脉自控镇痛。比较两组术后镇痛泵使用情况、不良反应发生情况。比较两组手术前后疼痛程度[视觉模拟量表(VAS)评分]及疼痛介质指标[前列腺素E2(PGE2)、P物质(SP)]水平。结果与术前相比,两组术后8、12、24 h的VAS评分呈下降趋势(P<0.05);术后8、12、24 h,观察组VAS评分低于对照组(P<0.05)。术后,观察组镇痛泵首次按压时间短于对照组(P<0.05);术后48 h内,观察组镇痛泵按压次数少于对照组(P<0.05);观察组术后补救镇痛率(5.41%,2/37),低于对照组(25.00%,9/36),P<0.05。术后24 h,两组PGE2、SP水平高于术前(P<0.05),观察组PGE2、SP水平低于对照组(P<0.05)。观察组不良反应总发生率(5.41%,2/37)与对照组(13.89%,5/36)比较差异未见统计学意义(P>0.05)。结论酮咯酸氨丁三醇联合盐酸纳布啡静脉自控镇痛可有效调控术后疼痛介质水平,延长镇痛效应,减少镇痛泵按压次数,降低补救镇痛率,且安全性可靠。
Objective To observe the efficacy of ketorolac tromethamine combined with nalbuphine hydrochloride in intravenous patient-controlled analgesia after open reduction and internal fixation for lower limb fractures,and its influence on serum pain mediators.Methods A total of 73 patients who underwent open reduction and internal fixation for lower limb fractures in Nanyang First People’s Hospital from June 2022 to June 2023 were retrospectively selected as research objects.And they were divided into a control group(36 cases)and an observation group(37 cases)according to postoperative analgesia protocol.Both groups were given general anesthesia;the control group was given intravenous patient-controlled analgesia with nalbuphine hydrochloride,and the observation group was given intravenous patient-controlled analgesia with ketorolac tromethamine combined with nalbuphine hydrochloride.The use of postoperative analgesia pump and incidence of complications were compared between the two groups.The pain degree evaluated by visual analogue scale(VAS)score and levels of pain mediators,including prostaglandin E2(PGE2)and substance P(SP),were compared between the two groups before and after surgery.Results Compared with preoperative scores,the VAS scores in the two groups showed a downward trend at 8,12 and 24 hours after surgery(P<0.05);and the VAS scores in the observation group were lower than those in the control group at 8,12 and 24 hours after surgery(P<0.05).The first time of postoperative analgesic pump compression in the observation group was shorter than that in the control group(P<0.05),the frequency of postoperative analgesic pump compression within 48 hours after surgery was less than that in the control group(P<0.05).The rate of postoperative enhanced analgesia of the observation group(5.41%,2/37)was lower than that of the control group(25.00%,9/36),P<0.05.At 24 hours after operation,the levels of PGE2 and SP in the two groups increased compared with preoperative levels,and levels of PGE2 and SP in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the observation group(5.41%,2/37)and the control group(13.89%,5/36),P>0.05.Conclusions Ketorolac tromethamine combined with nalbuphine hydrochloride can effectively regulate the level of postoperative pain mediators,prolong the analgesic effect,reduce the frequency of analgesic pump compression,reduce the rate of enhanced analgesia,and ensure safety.
作者
张国栋
孙创
Zhang Guodong;Sun Chuang(Department of Anesthesia,Nanyang First People’s Hospital,Nanyang 473000,China)
出处
《中国实用医刊》
2024年第8期58-61,共4页
Chinese Journal of Practical Medicine
作者简介
通信作者:张国栋,Email:ZG15462332@163.com。
