小剂量吗啡和倍他米松在膝关节镜术后镇痛中的应用(英文)

Analgesic effect of low-dose intra-articular morphine and diprospan after knee arthroscopy

目的:观察小剂量吗啡和复方倍他米松注射液联合应用于关节内注射对膝关节镜术后的镇痛效果。方法:①选择2002-02/2003-01解放军第二军医大学长征医院骨科关节外科行择期膝关节镜手术患者100例,其中男52例,女48例,年龄16～56岁,术前均无服用镇痛药物史。美国麻醉医师协会手术前分级Ⅰ～Ⅱ级,无明显的心、肺、肝等病史,且均对治疗方案知情同意。②将患者按随机数字表法分为2组:联合用药组和吗啡组,每组50例。联合用药组手术后在关节内注射盐酸吗啡1mg和复方倍他米松1mL(比利时先灵葆雅制药厂生产,批号:4JBBKA35A,规格:1mL(5mg/2mg)/支);吗啡组注射盐酸吗啡1mg(沈阳第一制药厂生产,批号:020316,规格:1mL(10mg)/支)。③观察给药后8和24h采用目测类比评分(0￣10分,评分越高表示疼痛越强烈)在患者双足站立、膝关节伸展状态下进行镇痛效果评估。术后48h观察各种不良反应的发生情况。④数据间差异比较采用单因素方差分析,两组间的进一步差异性比较采用q检验。结果:行择期膝关节镜手术患者100例均进入结果分析。①目测类比评分:给药后8h,联合用药组与吗啡组相近,分别为(1.41±0.74),(1.52±0.65)分(q=2.72,P>0.05)。给药后24h,联合用药组明显低于吗啡组[(1.46±0.61),(2.53±1.24)分,q=3.42,P<0.05]。②不良事件和副反应:两组均未出现静脉应用吗啡可能发生的不良反应。结论:小剂量吗啡和复方倍他米松注射液联合应用于关节内注射的镇痛效果明显优于单纯使用吗啡,且用药安全。

AIM： To evaluate the analgesic effects of combining application of low-dose morphine and diprospan in intra-articular injection after knee arthroscopy. METHODS： ① A total of 100 patients with knee arthroscopy were selected from the Surgery of Joint, Department of Orthopaedics, Changzheng Hospital, the Second Military Medical University of Chinese PLA from February 2002 to January 2003, including 52 males and 48 females aged from 16 to 56 years. All of them did not have a history of administration of pain-killer before operation. Patients were classified from grade Ⅰ to grade Ⅱ based on American Society of Anesthesiologists （ASA） before operation. Meanwhile, all the patients did not have obvious histories of heart, lung and liver diseases, and all patients provided informed consent. ② All patients were randomly divided into two groups, including combination group and morphine group with 50 in each group. Patients in the combination group were given intra-articular injection with 1 mg morphine hydrochloride and 1 mL compound diprospan [Xianling Baoya Pharmaceutical Factory, Belgian; batch number： 4JBBKA35A; qualification： 1 mL （5 mg/2 mg）/ampoule] after operation. In addition, patients in morphine group were injected with 1 mg morphine hydrochloride [the First Pharmaceutical Factory, Shenyang; batch number： 020316; qualification： 1 mL （10 mg）/ampoule]. ③ At 8 and 24 hours after administration, when patients maintained the status of standing with both feet and unfolding knee joint, analgesic effect was evaluated by visual analogue scale （VAS）. Scores ranged from 0 to 10. The higher the scores were, the severer the painfulness was. Moreover, various side effects were observed at 48 hours after operation. ④ Differences of data were compared with one-way analysis of variance and deep differences between the two groups were compared with q test. RESULTS： A total of 100 patients received knee arthroscopy were involved in the final analysis. ① Visual analogue scale： At 8 hours after administration, scores were similar in combination group to those in morphine group, and the scores were 1.41±0.74 and 1.52±0.65, respectively （q =2.72, P 〉 0.05）. At 24 hours after administration, scores were remarkably lower in combination group than those in morphine group, and the scores were 1.46±0.61 and 2.53±1.24, respectively （q =3.42, P 〈 0.05）. ② Adverse events and side effects： Side effects, which were always found out in the application of morphine in vein, were not observed in both combination group and morphine group. CONCLUSION： Combining application of low-dose morphine and compound diprospan has an excellent analgesic effect with intra-articular injection, which is superior to that of the single application of morphine. Meanwhile, the combining application of low-dose morphine and compound diprospan is safe,