多模式联合镇痛在成人创伤性肋骨骨折非手术治疗初期中的应用

Application of multi-mode combined analgesia in the early stage of non-operative treatment of traumatic rib fractures in adults

目的评估新型多联合镇痛模式在成人创伤性肋骨骨折非手术治疗初期的镇痛效果。方法前瞻性纳入2014年1月至2018年1月93例未接受手术治疗的创伤性肋骨骨折患者,按数字表法随机分为传统镇痛组、皮下镇痛组和联合镇痛组,每组31例。其中男56例,女37例;平均(47.3±13.2)岁。所有患者均为中重度疼痛,VAS评分大于5分。传统镇痛组:每天2次给予氯诺昔康8 mg静脉注射;皮下镇痛组:单纯使用皮下自控镇痛泵治疗;联合镇痛组:在传统镇痛组的基础上,加用皮下自控镇痛泵治疗,泵药配置用量同皮下镇痛组。比较伤后3天内卧床制动期间各组患者镇痛治疗前(T1),治疗后24 h(T2)、48 h(T3)、72 h(T4)的静息时和咳嗽时的VAS评分。比较镇痛治疗78 h后下床活动时的VAS评分。当各组患者卧床治疗72 h内出现VAS评分大于7的突发疼痛时,比较各组使用盐酸布桂嗪100 mg补救镇痛的日均使用次数。比较皮下镇痛组和联合镇痛组的患者卧床治疗期间镇痛泵的日均按压次数。比较各组出现恶心、肺炎等不良反应例数。结果联合镇痛组的静息痛和咳嗽痛在观测时点(T2~T4)上的VAS评分均优于皮下镇痛组和传统镇痛组,差异有统计学意义(P<0.05)。下床活动时,3组间的疼痛评分差异有统计学意义(P<0.05),联合镇痛组的疼痛评分最低。补救镇痛时,盐酸布桂嗪日追加次数3组间差异有统计学意义(P<0.05),联合镇痛组次数最少。使用镇痛泵的两组患者之间,联合镇痛组自主按压次数低于皮下镇痛组(P<0.05)。联合镇痛组治疗期间的肺炎发生率低于其他两组,恶心等不良反应的发生率低于单纯镇痛组。结论成人创伤性肋骨骨折非手术治疗初期,传统静脉间断给药联合皮下持续给药的的多模式镇痛效果优于传统静脉或皮下给药的单一镇痛模式,且无明显不良反应。

Objective To evaluate the analgesic effect of a new combined analgesic mode in the early stage of non-operative treatment of adult traumatic rib fractures.Methods A total of 93 patients with rib fractures who did not receive surgical treatment from January 2014 to January 2018 were prospectively included,and randomly divided into the traditional analgesia group,subcutaneous analgesia group and combined analgesia group(31 cases each).There were 56 males and 37 females totally with a median age of(47.3±13.2)years.All patients have moderate to severe pain with VAS scores greater than 5.Traditional analgesia group:lornoxicam 8 mg intravenous injection twice daily.Subcutaneous analgesia group:only subcutaneous self-controlled analgesia pump was used for treatment.Combined analgesia group:on the basis of the traditional analgesia group,subcutaneous self-controlled analgesia pump was added for treatment,and the dosage of the pump drug was the same as that of subcutaneous analgesia group.The VAS scores at tranquillization and cough were compared before analgesia treatment(T1),24 h(T2),48 h(T3)and 72 h(T4)after analgesic treatment in each group during bed brake within 3 days after injury.The VAS scores after 78 hours of analgesic treatment during ambulation were compared.When sudden pain with VAS score greater than 7 occurred within 72 hours of bed staying treatment in each group,the average daily use times of bucinnazine hydrochloride 100mg remedial analgesia were compared.The number of adverse reactions such as nausea and pneumonia in each group was compared.Results The VAS scores of resting pain and cough pain at the observation time point(T2-T4)in the combined analgesia group were better than those in the subcutaneous analgesia group and the traditional analgesia group,showing a significant difference(P<0.05).When getting out of bed,there were significant differences in pain scores among the three groups,and the pain score of the combined analgesia group was the lowest.There was a significant difference among the three groups in the number of daily additions of bucinnazine hydrochloride during remedial analgesia(P<0.05),the combined analgesia group was the least.Between the two groups of patients using analgesic pump,the number of self-compressions in the combined analgesia group was lower than that in the subcutaneous analgesia group(P<0.05).The incidence of pneumonia in the combined analgesia group was lower than that in the other two groups and the incidence of other adverse reactions such as nausea was lower than that in the simple analgesia group.Conclusion In the early stage of non-operative treatment of traumatic rib fractures in adults,the multi-mode analgesic effect of traditional intravenous intermittent administration combined with subcutaneous continuous administration is superior to the single analgesic mode of traditional intravenous or subcutaneous administration with no obvious adverse reactions.