穴位注射复合帕瑞昔布在下肢创伤急性镇痛的疗效探讨

Study on Curative Effect of Point Injection Combined with Parecoxib in Lower Limb Trauma Acute Analgesia

目的探讨穴位注射复合帕瑞昔布在下肢创伤急性镇痛中的应用效果。方法选择2016年1月—2017年9月在该院接受治疗的105例下肢创伤急性疼痛患者,随机分为实验I组、实验II组和实验III组,每组35例。其中实验I组患者给予阿片类镇痛药物,实验II组患者给予40 mg帕瑞昔布静脉或肌肉注射(经处理后VAS评分大于7分者,再给予阿片类药物辅助镇痛),实验III组患者则给予足三里、阳陵泉穴位注射1%利多卡因联合40 mg帕瑞昔布静脉或肌肉注射(经处理后VAS评分大于7分者,再给予阿片类药物辅助镇痛)。比较3组患者治疗后即刻、10 min、1 h、2 h的MAP、HR及VAS评分变化情况,观察并记录3组患者治疗期间不良反应发生情况。结果治疗后3组患者的MAP、HR及VAS均呈现降低趋势(P<0.05)。其中治疗后10 min实验II组MAP明显低于实验I组(P<0.05),实验II组和III组的HR、MAP及VAS评分均差异无统计学意义(P>0.05);治疗后1h实验II组和III组的MAP和VAS评分分别为(95±6.3)mm Hg、(5.7±1.3)分、(94±6.6)mm Hg、(4.9±1.1)分,实验I组为(99±7.3)mm Hg和(6.3±1.4)分,其中实验Ⅱ组和Ⅲ组的MAP和VAS评分均明显低于实验Ⅰ组,实验III组的VAS评分也明显低于实验II组(P<0.05);治疗后2 h实验III组的MAP明显低于实验I组,实验II组和III组的HR和VAS评分均明显低于实验I组,且实验III组的VAS评分也明显低于II组(P<0.05)。实验III组患者不良反应发生率明显低于实验I组(28.57%vs 2.85%,χ2=8.737,P=0.003)和实验II组(11.43%vs 2.85%,χ2=4.629,P=0.031)。结论穴位注射联合帕瑞昔布应用下肢创伤急性镇痛中效果显著,还可明显缓解创伤对机体的应激反应,且不良反应轻微,安全性高,值得临床推广应用。

Objective To study the application effect of point injection combined with parecoxib in lower limb trauma acute analgesia.Methods 105 cases of patients with lower limb trauma acute analgesia treated in our hospital from January 2016 to September 2017 were selected and randomly divided into three groups including the experimental I group,experimental II group and experimental III group with 35 cases in each,the experimental I group were treated with opioid analgesics,the experimental II group adopted the intravenous or muscular injection of 40mg parecoxib(the patients whose VAS score was more than 7 were treated with adjuvant analgesia of opioids,and the changes of MAP,HR and VAS scores immediately,in 10 min,1 h,and 2 h were compared between the three groups and the occurrence of adverse reactions during treatment of the three groups was observed and recorded.Results After treatment,the MAP,HR and VAS scores showed a decreasing trend(P<0.05),after treatment,the MAP in the experimental II group was obviously lower than that in the experimental I group(P<0.05),and there were no obvious differences in the HR,MAP and VAS scores between the experimental II group and experimental III group(P>0.05),and the MAP and VAS scores in the experimental II group and experimental III group at 1 h after treatment were obviously lower than those in the experimentalⅠgroup[(95±6.3)mmHg,(5.7±1.3)points,(94±6.6)mmHg,(4.9±1.1)points vs(99±7.3)mmHg,(6.3±1.4)points],at 2 h after treatment,the MAP in the experimental III group was obviously lower than that in the experimental I group,and the HR and VAS scores in the experimental II group and in the experimental III group were obviously lower than those in the experimental I group,and the VAS score in the experimental III group was obviously lower than that in the experimental II group(P<0.05),and the incidence rate of adverse reactions in the experimental III group was obviously lower than that in the experimental I group(28.57%vs 2.85%,χ2=8.737,P=0.003)and in the experimental II group(11.43%vs 2.85%,χ2=4.629,P=0.031).Conclusion The application effect of point injection combined with parecoxib in lower limb trauma acute analgesia is obvious,which can obviously relieve the stress reactions of wound to organs,with mild adverse reactions and high safety,and it is worth clinical promotion and application.