美洛昔康针剂用于脊柱外科围手术期镇痛初步观察

A preliminary evaluation of the perioperative analgesic effect of intramuscular meloxicam administration on patients undergoing spinal surgery

目的观察美洛昔康肌肉注射和口服两种不同给药方式用于脊柱外科围手术期的镇痛效果及安全性。方法 118例接受脊柱手术患者中腰椎融合37例,显微内镜腰椎间盘髓核摘除(MED)60例,脊柱肿瘤切除重建14例,脊柱后凸畸形截骨矫形7例。所有患者随机分为两组:美洛昔康针剂给药组(A组)58例,术前1天15 mgIM,术后第1～7天15 mg IM QD;美洛昔康口服给药组(B组)60例,术前1天15 mg PO,术后第1～7天15 mg PO QD。两组术后均不限制使用静脉止痛泵、肌注或口服阿片类药物。观察两组术后疼痛视觉模拟评分(VAS)、阿片类药物用量、相关并发症以及术后1个月患者综合满意度。结果术后第1、2、3、7天两组患者VAS评分比较的差异,有统计学意义(P<0.05);术后阿片类药物累计使用率,A组为15.52%,B组为60%(P<0.05);两组均未观察到面部浮肿、血压异常升高等心血管不良反应,B组7例出现恶心或呕吐等胃肠道不良反应;术后1个月综合满意度,A组为87.5%,B组为80.8%(P<0.05)。结论脊柱手术患者围手术期使用美洛昔康针剂能有效缓解术后疼痛,减少术后阿片类止痛药的使用和不良反应,提高患者对手术的综合满意度。

Objective To evaluate the perioperative analgesic effect and safety of intramuscular and oral meloxicam administration on patients underwent spinal surgery.Methods One hundred and eighteen patients underwent spinal surgery, including 37 cases of lumbar interbody fusion,60 of microendoscopic discectomy（MED）,14 of tumor resection and 7 of spinal correction,were randomly divided into two groups.For the 58 patients in group A,15 mg meloxicam was administrated intramuscularly once a day from the day before surgery to the 7th day postoperatively,while in group B the 60 patients orally took 15 mg meloxicam once a day for the same period of time as group A.All patients,if needed,unrestrictedly received intravenous analgesic pump,injected or oral opioids after surgery.Data of pain intensity measured by visual analog scale（VAS）,frequency of opioids administration and complications were collected on day 1,2,3 and 7 postoperatively,and overall satisfaction was evaluated on the follow-up 1 month after surgery as well.Results The main VAS score in group A was lower than that in group B on the 1st,2nd,3rd and 7th day after surgery（P0.05）,while the frequency of opioids administration in group B was higher than that in group A（60%vs 15.5%,P0.05）.Seven patients in group B complained nausea or vomiting after surgery,no adverse reactions related to cardiovascular system were observed in both groups.On the follow-up 1 month postoperatively,the incidence of patients with satisfaction for surgery in group A was higher than that in group B（87.5%vs 80.8%,P0.05）.Conclusion Perioperative intramuscular meloxicam is an effective method for reducing postoperative pain and opioids consumption in patients undergoing spinal surgery.