皮内注射地塞米松用于下肢长骨手术后的镇痛

Analgetic effects of post-operative intradermal injection of decacortin on long bone fracture at lower limbs

目的:观察皮内注射地塞米松在下肢长骨手术后的镇痛效果。方法:选取2003/04-2004/12在连云港市第一人民医院确诊为患有下肢长骨骨折的择期手术患者40例。随机分地塞米松组、布比卡因组、生理盐水组和空白对照组四组,每组10例。在手术范围内的脊神经的皮肤分布区给药,距手术切口5cm以上,进针深度约0.1cm,每个皮丘注入1～1.5mL药液,直径为1.5～2cm苍白桔皮样皮丘,皮丘间隔1.5cm。如手术超过4h,即放弃这一实验。所有患者均采用目测类比评分法(VAS)评分(0～10刻度,0为无痛,10为剧痛。术后2h开始评分,2h/次,共4次)评估镇痛效果。结果:因手术超时放弃5例,又因手术后疼痛难忍,放弃4例,最终进入结果分析31例。地塞米松组患者的目测类比评分法(VAS)评分均低于布比卡因组、生理盐水组、空白对照组(2.30±1.04,4.76±1.78,5.47±0.99,6.03±1.48,t=-3.5312,-6.1738,-5.9320,P<0.05)。结论:皮内注射小剂量地塞米松对下肢长骨手术后有显著镇痛效果。

AIM： To observe the analgesic effects of intradermal injection of decacortin after operation on long bone fracture at lower limbs. METHODS： Forty patients with long bone fracture at lower limbs between April 2003 and December 2004 were selected from First People＇s Hospital of Lianyungang. All subjects were randomly divided into decacortin group, bupivacaine group, normal saline group and blank control group with 10 patients in each group. The skin area of spinal nerve within the operational range were administrated with a 0.1-cm-deep needling at 5 cm above the operative incision. Each site was injected with 1-1.5 mL injection, which were pale and similar to orange-peel with the diameter between 1.5 cm and 2 cm, and there was a 1.5-cm distance between each two. The experiment was given up if the operation was over 4 hours. All subjects were scored with visual analogue scales （VAS） （the scores ranged from 0 to 10, 0 represented no pain and 10 represented severe pain. Patients were scored at 2 hours after operation once every two hours for totally 4 times）, so as to evaluate the analgetic effects. RESULTS： Five patients gave up the operation for overlong time and 4 patients gave up for severe pain after operation. A total of 31 patients were involved in the analysis of results. The score of VAS was lower in patients of decacortin group than bupivacaine group, normal saline group and blank control group （2.30±1.04,4.76±1.78,5.47±0.99,6.03±1.48,t=-3.531 2, -6.173 8,-5.932 0,P 〈 0.05）. CONCLUSION： Intradermal injection of decacortin at low dose has significant analgetic effects on patients received operation of long bone fracture at lower limbs.