镇静/镇痛下肩关节手法松解术治疗难治型粘连性肩周炎后联合舒芬太尼镇痛的短期疗效

Efficacy of the postoperative sufentanil analgesia on refractory adhesive scapulohumeral periarthritis by manipulation release of shoulder joint under sedation/analgesia

目的探讨舒芬太尼在镇静/镇痛下肩关节手法松解治疗难治型粘连性肩周炎治疗后镇痛的短期疗效观察。方法收集2018年11月至2020年7月在厦门医学院附属第二医院疼痛科诊断为难治型粘连性肩周炎的患者48例, 随机数字分组法分为治疗后镇痛组(有泵组, n=24)和治疗后无镇痛组(无泵组, n=24), 两组患者均进行臂丛神经阻滞和异丙酚静脉推注及痛点注射的镇静/镇痛后给予肩关节粘连手法松解, 治疗后均予以氟比洛芬酯50 mg配入0.9%氯化钠注射液100 ml静脉滴注, 有泵组治疗后2 h予以150 μg舒芬太尼注射液配入0.9%氯化钠注射液共150 ml, 镇痛泵3 ml/h持续静脉泵入50 h;无泵组则否。对两组患者治疗前、治疗后1 d、1及3个月时NRS评分、肩关节功能CMS评估及疗效评估进行比较。结果两组患者各时点较治疗前NRS评分均明显降低, CMS评分均明显升高, 差异有统计学意义(P均<0.05);与无泵组相比较, 有泵组患者治疗后1 d及1个月时NRS评分均降低, CMS评分均升高, 差异有统计学意义(P均<0.05);治疗后3个月时两组NRS评分及CMS评分比较差异无统计学意义(P均>0.05)。治疗后1 d时, 有泵组患者NRS评分0~3分例数多, 与无泵组比较差异有统计学意义(χ2=10.55, P<0.05)。两组患者治疗后1及3个月时NRS评分0~3分例数差异无统计学意义(P均>0.05)。两组患者治疗后1 d时疗效比较差异有统计学意义(P均<0.05), 治疗后1及3个月时疗效比较, 差异无统计学意义(P>0.05)。治疗后各时点有泵组治疗满意率均较无泵组高。结论静脉泵入舒芬太尼能有效缓解镇静/镇痛下肩关节粘连松解术治疗难治性粘连性肩关节炎治疗后肩部疼痛并改善肩关节功能。

Objective To explore the efficacy of sufentanil on postoperative analgesia of refractory adhesive scapulohumeral periarthritis by manipulation release of shoulder joint under sedation/analgesia.Methods Forty-eight patients with refractory adhesive scapulohumeral periarthritis were collected in the Pain Department of the Second Affiliated Hospital of Xiamen Medical College from November 2018 to July 2020,and divided into postoperative analgesia group(n=24)and postoperative non-analgesia group(n=24)by the random number grouping method.Patients were given manipulation release of shoulder joint adhesion after brachial plexus block,propofol intravenous injection and pain point injection for sedation/analgesia in both groups.All patients were given flurbiprofen axetil 50 mg combined with 0.9%sodium chloride injection 100 ml,intravenous infusion.Two hours after the treatment,the patients was given 150μg sufentanil combined with 150 ml 0.9%sodium chloride in the postoperative analgesia group administered intravenously with analgesic pump at 3 ml/h for 50 hours after the treatment.The postoperative non-analgesia group was not.The NRS,shoulder function assessment Constant-Murley score(CMS)and efficacy evaluation in the two groups were compared before the operation,1 day,1 month and 3 months after the treatment.Results The NRS was significantly lower and CMS significantly higher than those before the treatment with statistical significance(all P<0.05).Compared with the postoperative non-analgesia group,the NRS scores decreased in the postoperative analgesia group and the CMS increased at 1 day and 1 month after treatment with statistical significance(all P<0.05),but there was no significant difference in the NRS score and CMS score between the two groups at 3 months after the treatment(all P>0.05).On the first day after treatment,there was significant difference in the number of patients with NRS score of 0-3 between the two groups(χ2=10.55,P<0.05).There was no significant difference in the number of cases with NRS score 0-3 between the two groups at 1 month and 3 months after the treatment(all P>0.05).There was significant difference in the efficacy between the two groups at 1 day after treatment(all P<0.05),but there was no significant difference at 1 month and 3 months after the treatment(all P>0.05),the treatment satisfaction rate was higher in the postoperative analgesia group than that in the postoperative non-analgesia group at each time point after treatment.Conclusion Intravenous infusion of sufentanil can effectively relieve postoperative shoulder pain and improve its function after manipulation release of refractory adhesive scapulohumeral periarthritis under sedation/analgesia.