酮咯酸氨丁三醇用于鼻内镜术后换药镇痛的观察

Observation on the analgesic effect of ketorolac tromethamine in dressing change after endoscopic sinus surgery

目的观察酮咯酸氨丁三醇预防性镇痛对鼻内镜手术患者术后换药拔除鼻腔止血海绵时疼痛的影响。方法选取2020年3月-2022年9月我院择期在全身麻醉下行鼻内镜鼻中隔偏曲矫形术的患者100例,随机分为酮咯酸氨丁三醇组(K组)和对照组(C组),每组50例。两组患者均在手术结束时鼻腔填塞膨胀止血海绵,术后24小时行鼻腔换药取出鼻腔膨胀止血海绵。换药前,K组静脉给予酮咯酸氨丁三醇30mg,C组静脉给予的生理盐水对照,在给药结束后半小时行鼻腔换药拔除鼻腔膨胀止血海绵。记录患者的疼痛敏感度(PSQ)、换药时及换药后24小时的疼痛视觉模拟评分(VAS)、术前基础心率(HR)和平均动脉压(MAP)、换药前后HR和MAP变化值,以及不良反应发生情况(恶心、呕吐、头晕、鼻腔出血量)。结果K组换药时VAS疼痛评分、换药前后心率和平均动脉压变化值均低于C组,两组比较,差异均有统计学意义(P<0.05);比较两组换药时鼻腔出血量、不良反应发生率,差异无统计学意义(P>0.05)。结论鼻内镜手术患者换药时拔除鼻腔膨胀止血海绵时使用酮咯酸氨丁三醇可达到有效的预防性镇痛的作用,且不增加患者鼻出血、恶心、呕吐、头晕等不良反应的发生。

Objective To observe the clinical effect of preventive analgesia of Ketorolac on pain in patients underwent the first nasal dressing change after endoscopic sinus surgery,and removal of nasal swelling hemostatic sponge.Methods All patients underwent nasal endoscopic septoplasty from March 2020 to September 2022.Patients were randomly divided into two groups:Ketorolac group(K group)and control group(C group),with 50 patients in each group.All patients had nasal hemostatic spongeminutes,that were removed 24 hours after surgery.The K group was given intravenous Ketorolac 30 mg and normal saline 100ml,and the C group was given intravenous normal saline 100ml,at 30 minutes before the first dressing change.The two groups were recorded for the visual analogue scale(VAS)of pain,pain sensitivity questionnaire(PSQ),changes of mean arterial pressure(MAP)and heart rate(HR)before and after dressing change,amount of nasal bleeding,and the incidence of adverse reactions.Results The pain VAS scores,changes of MAP and heart rate in group K were lower than those in group C,and the differences between the two groups were statistically significant(P<0.05).The amount of nasal bleeding and the incidence of adverse reactions(nausea,vomiting,dizziness)were not significantly compared between the two groups(P>0.05).Conclusion The use of Ketorolac tromethamine can achieve effective preventive analgesia when patients undergoing nasal endoscopic surgery remove the nasal cavity swelling hemostatic sponge during dressing change,and does not increase the occurrence of adverse reactions such as epistaxis,nausea,vomiting,dizziness,etc.