酮咯酸对经皮穿刺椎体成形术患者的术后镇痛效果影响及安全性分析

Evaluation of the analgesic efficacy and safety of ketorolac in patients undergoing percutaneous vertebroplasty

目的评价酮咯酸对经皮穿刺椎体成形术(PVP)患者术后的镇痛效果影响及安全性。方法回顾性分析2020年1月至2023年5月在西安工会医院行PVP患者的临床资料,根据患者术后是否使用酮咯酸,将其分为酮咯酸组和对照组。比较两组患者术前、术后6,24,48 h的视觉模拟疼痛评分(VAS),术后芬太尼使用情况(用量、第1次按压镇痛泵时间、按压次数),术前、术后3 d、1个月及6个月的Oswestry残疾指数(ODI),术前、术后3个月和6个月时的骨密度和骨代谢指标,术后72 h内的不良反应发生率及疼痛干预满意度。结果研究共纳入患者90例,酮咯酸组48例,对照组42例。术后6,24,48 h,与对照组相比,酮咯酸组患者的VAS评分显著降低(P<0.05)。酮咯酸组患者术后48 h的芬太尼使用量和按压次数均显著低于对照组,第1次按压镇痛泵时间显著长于对照组(P<0.05)。两组患者术前的骨密度、血清骨特异性碱性磷酸酶(BALP)和I型胶原C端肽(CTX-I)水平比较差异无统计学意义(P>0.05)。术后3个月和6个月时,两组患者的骨密度、血清BALP、CTX-I水平均较术前显著改善(P<0.05);术后3 d、1个月和6个月,两组患者的ODI均较术前显著改善(P<0.05)。酮咯酸组患者术后72 h的不良反应发生率与对照组相比差异无统计学意义(P>0.05)。此外,酮咯酸组患者的疼痛缓解满意度显著高于对照组患者(P<0.05)。结论酮咯酸具可有效改善PVP患者的术后疼痛,且不会影响患者的术后恢复,不良反应发生率较低,安全性较高,能有效提高患者的疼痛缓解满意度。

Objective To evaluate the effect and safety of ketorolac on postoperative analgesia in patients undergoing percutaneous vertebroplasty.Methods The clinical data of patients who underwent percutaneous vertebroplasty in Xi'an Labor Union Hospital from January 2020 to May 2023 were retrospectively analyzed,and the patients were divided into ketorolac group and control group according to whether they were given ketorolac after surgery.The visual analogue pain score(VAS)before,6 h,24 h and 48 h after surgery,postoperative fentanyl usage(dosage,time of first compression analgesic pump,number of compressions),Oswestry disability index(ODI)before,3 days,1 month and 6 months after surgery,bone mineral density and bone metabolism indexes before,3 month and 6 month after surgery,the incidence of adverse reactions within 72 hours after surgery and satisfaction with pain intervention were compared between the two groups.Results A total of 90 patients were included in the study,including 48 patients in the ketorolac group and 42 patients in the control group.At 6 h,24 h and 48 h after surgery,the VAS score of the ketorolac group was significantly lower than that of the control group(P<0.05).The amount of fentanyl and the number of compressions in the ketorolac group were significantly lower than those in the control group,and the time of the first compression analgesic pump was significantly longer than that in the control group(P<0.05).There was no significant difference in bone mineral density,serum bone-specific alkaline phosphatase(BALP)and type I collagen C-terminal peptide(CTX-I)levels between the two groups before surgery(P>0.05).At 3 months and 6 months after surgery,the bone mineral density,serum BALP and CTX-I levels of the two groups were significantly improved compared with those before surgery(P<0.05).At 3 days,1 month and 6 months after surgery(P<0.05),the ODI of patients in both groups was significantly improved compared with that before surgery.There was no significant difference in the incidence of adverse reactions at 72 hours after surgery between patients in the ketorolac group and the control group(P>0.05).In addition,the satisfaction with pain relief in the ketorolac group was significantly higher than that in the control group(P<0.05).Conclusion Ketorlac can effectively improve the postoperative pain of patients with PVP without affecting the postoperative recovery of patients,with a low incidence of adverse reactions and a high safety profile,which can effectively improve patients'satisfaction with pain relief.