地佐辛联合地塞米松对全膝关节置换术镇痛的临床疗效研究

A study of clinical effects of dezocine combined with dexamethasone in total knee arthroplasty

目的探讨地佐辛联合地塞米松应用于全膝关节置换术(total knee arthroplasty,TKA)患者术后镇痛的临床疗效。方法选取我院关节外科80例行TKA的患者,随机均分为A组(地佐辛联合地塞米松)、B组(地佐辛)、C组(地塞米松)、D组(生理盐水),每组各20例,A组术前30 min静脉注射地佐辛0.1 mg/kg及地塞米松10 mg,B组术前30 min静脉注射地佐辛0.1 mg/kg,C组术前30 min静脉注射地塞米松10 mg,D组为对照组。术毕患者均采用舒芬太尼自控静脉镇痛(patient-controlled analgesia,PCIA)。观察患者术后镇痛效果、膝关节功能相关指标、术后舒芬太尼使用量、睡眠满意度、恶心及呕吐等不良反应。结果疼痛视觉模拟评分(visual analogue scale,VAS)术后6 h,A、B、C组分别为:(5.01±1.20)分、(5.52±1.15)分、(6.23±1.26)分,低于D组的(6.71±1.68)分(P=0.031、P=0.040、P=0.021);VAS术后12 h,A、B、C组分别为:(4.43±1.04)分、(4.87±1.42)分、(5.03±1.28)分,低于D组的(6.01±1.80)分(P=0.002、P=0.007、P=0.002);VAS术后1天,A、B、C组分别为:(2.89±0.92)分、(3.01±1.32)分、(3.76±1.45)分,低于D组的(4.71±1.81)分(P=0.035、P=0.019、P=0.024);VAS术后3天,A、B、C组分别为:(1.58±0.53)分、(1.87±0.64)分、(2.45±0.82)分,低于D组的(3.38±1.02)分(P=0.015、P=0.040、P=0.046);VAS术后5天,A、B、C组分别为:(1.07±0.32)分、(1.62±0.43)分、(2.01±0.51)分,低于D组的(3.11±0.82)分(P=0.007、P=0.008、P=0.009)。VAS术后1天,B和C组分别为(3.01±1.32)分、(3.76±1.45)分,高于A组的(2.89±0.92)分(P=0.005、P=0.004)。膝关节活动度(range of motion,ROM)术后2天,A、B组分别为:(30.27±5.81)°、(29.02±4.79)°,优于D组的(16.27±2.43)°(P=0.003,P=0.006)。ROM术后2周,A、B组别为:(98.21±9.05)°、(94.57±8.64)°,优于D组的(85.36±8.01)°,(P=0.007,P=0.002);ROM术后2天、2周C组(20.01±3.72)°、(93.10±8.20)°,优于D组的(16.27±2.43)°、(85.36±8.01)°(P=0.043,P=0.037);HSS(the hospital for special surgery)膝关节功能评分术后1周,A、B组分别为:(90.25±3.67)分、(89.16±2.32)分,均优于C、D组的(76.12±4.23)分、(73.21±2.31)分(P=0.002、P=0.004)。术后使用舒芬太尼,A组250μg,低于B组的60 500μg,也低于D组的10 5000μg。睡眠满意度A、B组分别为:(5.01±0.46)分、(4.89±0.42)分,高于D组的(2.81±0.65)分(P=0.023,P=0.042)。术后恶心、呕吐和谵妄的A、C组分别5例、2例,少于B、D组的10例、13例。结论地佐辛联合地塞米松超前镇痛应用于TKA可以明显缓解患者术后疼痛、提高患者满意度、促进患者术后康复、减少不良反应,值得临床推广。

Objective To discuss the clinical effects of dezocine combined with dexamethasone in analgesia in the patients after total knee arthroplasty. Methods A total of 80 patients receiving total knee arthroplasty were randomly divided into 4 groups. Group A： dezocine combined with dexamethasone（ 30 min preoperatively, intravenous, dezocine 0.1 mg / kg and 10 mg dexamethasone）; Group B： dezocine（ 30 min preoperatively, intravenous, dezocine 0.1 mg / kg）; Group C： dexamethasone（ 30 min preoperatively, intravenous, dexamethasone 10 mg）; Group D： saline（ the control group）; with 20 cases in each group. Patient-controlled analgesia（ PCIA） was applied postoperatively. The postoperative analgesia effects, knee joint function related indicators, sufentanil dosage, sleep satisfaction and adverse reactions such as nausea and vomiting were observed. Results The VAS pain scores were（ 5.01 ± 1.20）,（ 5.52 ± 1.15） and（ 6.23 ± 1.26） points respectively at 6 hours after the operation in group A, B and C, which were lower than（ 6.71 ± 1.68） points in group D（ P = 0.031, P = 0.040, P = 0.021）. The VAS pain scores were（ 4.43 ± 1.04）,（ 4.87 ± 1.42） and（ 5.03 ± 1.28） points respectively at 12 hours after the operation in group A, B and C, which were lower than（ 6.01 ± 1.80） in group D（ P = 0.002, P = 0.007, P = 0.002）. The VAS pain scores were（ 2.89 ± 0.92）,（ 3.01 ± 1.32） and（ 3.76 ± 1.45） points respectively at 1 day after the operation in group A, B and C, which were lower than（ 4.71 ± 1.81） in group D（ P = 0.035, P = 0.019, P = 0.024）. The VAS pain scores were（ 1.58 ± 0.53）,（ 1.87 ± 0.64） and（ 2.45 ± 0.82） points respectively at 3 days after the operation in group A, B and C, which were lower than（ 3.38 ± 1.02） points in group D（ P = 0.015, P = 0.040, P = 0.046）. The VAS pain scores were（ 1.07 ± 0.32）,（ 1.62 ± 0.43） and（ 2.01 ± 0.51） points respectively at 5 days after the operation in group A, B and C, which were lower than（ 3.11 ± 0.82） points in group D（ P = 0.007, P = 0.008, P = 0.009）. The VAS pain scores were（ 3.01 ± 1.32） and（ 3.76 ± 1.45） points respectively at 1 day after the operation in group B and C, which were higher than（ 2.89 ± 0.92） points in group A（ P = 0.005, P = 0.004）. The ranges of motion（ ROM） were（ 30.27 ± 5.81） ° and（ 29.02 ± 4.79） ° respectively at 2 days after the operation in group A and B, which were better than（ 16.27 ± 2.43） ° in group D（ P = 0.003, P = 0.006）. The ROM were（ 98.21 ± 9.05） ° and（ 94.57 ± 8.64） ° respectively at 2 weeks after the operation in group A and B, which were better than（ 85.36 ± 8.01） ° in group D（ P = 0.007, P = 0.002）. The ROM in group C were（ 20.01 ± 3.72） ° and（ 93.10 ± 8.20） ° at 2 days and 2 weeks after the operation, which were better than（ 16.27 ± 2.43） ° and（ 85.36 ± 8.01） ° in group D（ P = 0.043, P = 0.037）. The knee functional scores were（ 90.25 ± 3.67） and（ 89.16 ± 2.32） respectively in group A and B at 1 week after the operation, which were better than（ 76.12 ± 4.23） and（ 73.21 ± 2.31） in group C and D（ P = 0.002, P = 0.004）. The postoperative use of sufentanil quantity was 250 g in group A, which was lower than 60 500 group B and 10 5000 g in group D. Compared with（ 2.81 ± 0.65） points in group D, the sleep satisfaction were（ 5.01 ± 0.46） and（ 4.89 ± 0.42） points in group A and B（ P = 0.023, P = 0.042）. The postoperative nausea, vomiting and delirium were found in 5 cases in group A and 2 cases in group C, which were less than 10 cases in group B and 13 cases in group D. Conclusions Analgesia by dezocine combined with dexamethasone can obviously relieve postoperative pain, improve patients＇ satisfaction, promote rehabilitation and reduce adverse reactions after the total knee arthroplasty, which is worthy of clinical popularization and application.