不同剂量硫酸镁关节腔给药对关节镜手术术后疼痛的影响

Effects of different dose of MgSO_4 intra-articular injection on postoperative pain after arthroscopy

目的探讨不同剂量硫酸镁对关节镜手术术后疼痛的影响。方法择期行膝关节镜手术83例,随机分为:M1组(n=28,关节腔注射硫酸镁400mg)、M2组(n=28,关节腔注射硫酸镁800mg)和C组(n=27,注射等容积0.9%氯化钠注射液)。术后使用喷他佐辛针肌肉注射追加止痛。观察三组术后喷他佐辛应用的量、不同时间患者静脉血浆Mg2+浓度、疼痛模拟视觉评分(VAS)及低血压、镇静程度、恶心呕吐发生率。结果与M2组比较,C组和M1组术后使用喷他佐辛的量均多于M2组,差异有统计学意义(t分别=15.62、13.68,P均<0.05)。与C组比较,M1组和M2组术后8h、24h的Mg2+浓度增高,尤其是术后8hMg2+的浓度增高明显,差异均有统计学意义(t分别=3.78、2.96、3.24、2.72,P均<0.05)。与M2组比较,C组和M1组血压发生率和镇静评分均低于M2组,差异均有统计学意义(χ2分别=7.89、5.24、7.62、8.06;t分别=2.13、3.05、2.89、3.18,P均<0.05);与C组比较,M1组和M2组的恶心、呕吐发生率和VAS评分均明显降低,差异均有统计学意义(χ2分别=7.32、8.28、9.27、10.02;t分别=3.82、4.76、4.88、5.25,P均<0.05)。结论关节腔内注射400mg硫酸镁对膝关节镜术后可产生良好的镇痛效果,降低术后疼痛,且不增加不良反应的发生。

Objective To study effects of different dose of magnesium sulfate on postoperatative pain after arthroscopy.Methods A total of 83 patients undergoing arthroscopy were randomly divided into three groups：M1 group（n=28,magnesium sulfate 400 mg）,M2 group（n=28,magnesium sulfate 800 mg） and C group（n=27,control group-sodium chloride）.Venous blood Mg2＋ concentration,visual analog scale（VAS）,low blood pressure,the level of sedation and the incidence of nausea and vomit at 8 hours,24 hours after operation were observed.Results Compared with M2 group,pentazocine dose were increased in group M1 and group C（t=15.62,13.68,P0.05）.Compared with the group C,venous blood Mg2＋ concentration of 8 hours and 24 hours in group M1 and M2 after operation were significantly increased,especially of 8 hours（t=3.78,2.96,3.24,2.72,P0.05）.Compared with M2 group,The incidence of low blood pressure and the level of analgesia were significantly lower in group C and M1（χ2 =7.89,5.24,7.62,8.06;t =2.13,3.05,2.89,3.18,P0.05）.Compared with C group,The incidence of nausea,vomit and VAS were significantly decreased in M1 and M2 groups（χ2=7.32,8.28,9.27,10.02;t =3.82,4.76,4.88,5.25,P 0.05）.Conclusions Intra articular injection of magnesium sufate could keep analgesia and reduce postoperative pain after arthroscopy and do not increase the incidence of complications.