地塞米松治疗急诊创伤患者疼痛的有效性和安全性随机对照研究

A randomized controlled study of the efficacy and safety of dexamethasone in the treatment of pain in patients with emergency trauma

目的研究地塞米松治疗急诊创伤患者疼痛的有效性和安全性。方法选取2015年12月至2016年12月入住我院骨科患者264例，计算机随机原则分为实验组和对照组，每组132例。实验组采用地塞米松磷酸钠注射液作为试验药物，对照组采用葡萄糖注射液作为安慰剂，医师分别于入院时（0 h）、受伤后6、12、24、48 h记录VAS评分和患者总体评价，白细胞介素6/血糖数值和止痛药摄入量。病区医师同时记录伤口愈合情况、住院时间、骨折愈合时间及不良事件。结果实验组患者在24 h和48 h VAS评分分别为（2.31±0.37）分与（1.21±0.13）分，明显低于对照组（4.12±0.54）分与（3.01±0.51）分，差异显著（F组内＝2 917.519，F组间＝137.507，F交互＝83.927，P均〈0.05）；入院48 h，实验组患者IL-6为（9.51±0.67） ng/L，明显低于对照组（12.43±1.23） ng/L（F组内＝3.452×106，F组间＝913.243，F交互＝456.891，P均〈0.05）；实验组患者手术切口愈合患者125例，愈合率为94.70%，对照组愈合患者104例，愈合率为78.79%，实验组明显优于对照组（χ^2＝14.865，P〈0.05）。实验组患者住院时间为（15.52±2.51） d，明显低于对照组患者（24.76±3.67） d （t＝23.876，P〈0.05）。实验组患者不良反应发生率为9.09%（12/132），略高于对照组7.58%（10/132），但差异无统计学意义（t＝0.095，P〉0.05）。结论地塞米松的急诊使用能安全有效地缓解患者术前疼痛，扩大地塞米松使用的适应证，有利于术后镇痛，减少吗啡类和非甾体类抗炎药物的使用，为多模式镇痛提供新的方式。

Objective To study the efficacy and safety of dexamethasone in the treatment of pain in patients with emergency trauma.Methods From December 2015 to December 2016, two hundred and sixty-four patients were enrolled in the study and randomly divided into the experimental group and the control group, each with 132 cases.In the experimental group, dexamethasone sodium phosphate injection was used as a test drug, and the control group was treated with glucose injection as a placebo.VAS score, overall evaluation, IL-6/ blood glucose and painkillers intake were recorded by physicians at the time of admission （0 h）, 6, 12, 24, 48 h after injury.At the same time, wound healing, hospitalization time, fracture healing time and adverse events were recorded.Results The 24 h and 48 h VAS scores in the experimental group were （2.31±0.37） and （1.21±0.13） points, which were significantly lower than those in the control group （（4.12±0.54） points, （3.01±0.51） points）. The difference was significant （F （time）=2 917.519, F（Group）=137.507, F （time ＊group）=83.927, P〈0.05）. The level of IL-6 in the experimental group was （9.51±0.67） ng/L, significantly lower than that in the control group （12.43±1.23） ng/L.（F （time）=3.452×106, F （group）=913.243, F （time ＊group）=456.891, P〈0.05）. In the experimental group, one hundred and twenty-five cases were healed with the healing rate of 94.70%, which was obviously superior to the control group （104 cases of healing and healing rate was 78.79%） （χ^2=14.865, P〈0.05）, and the hospitalization time of the experimental group was （15.52±2.51） d, which was significantly lower than that of the control group（ （24.76±3.67） d） （t=23.876, P〈0.05）. The incidence of adverse reactions in the experimental group was 9.09% （12/132）, which was slightly higher than that of the control group （7.58% （10/132））, but the difference was not statistically significant （t=0.095, P〉0.05）.Conclusion The emergency use of dexamethasone can safely and effectively alleviate preoperative pain and expand the indications of dexamethasone.It is beneficial to relieve postoperative analgesia, to reduce the use of morphine and NSAID drugs, and to provide a new way for multimodal analgesia.