盐酸羟考酮注射液和氟比洛芬酯注射液用于老年膝关节置换术后镇痛的效果比较

发布时间：2018-09-12 09:22

【摘要】：背景膝关节疾病是引起老年人下肢疼痛和致残的主要原因,膝关节置换手术可根治疾病。有效地控制术后疼痛,减轻应激反应,及早功能锻炼是手术成功的保证。盐酸羟考酮注射液是阿片受体激动剂,起效迅速,镇痛作用强,副作用小。氟比洛芬酯注射液是非甾体类抗炎药,具有解热、抗炎、镇痛等作用。阿片类药物和非甾体类药物是膝关节手术后常用的镇痛药,为寻找镇痛效果好、不良反应低,更有利于老年膝关节置换术后恢复的镇痛用药,了解两药的相同和不同之处,本研究选择阿片类药物盐酸羟考酮注射液和非甾体类药物氟比洛芬酯注射液用于老年膝关节置换术后,对其镇痛效果、炎症反应、应激反应及不良反应等方面进行对比观察。目的观察盐酸羟考酮注射液和氟比洛芬酯注射液在老年全膝关节置换术后镇痛的效果,对患者应激反应和炎症反应的影响以及不良反应;比较二者用于老年患者全膝关节置换术后镇痛的优缺点。方法经河南省人民医院学术与伦理委员会批准,选择该院2016年3月1日-2016年9月30日期间行全身麻醉下单侧全膝关节置换术的患者116例,年龄60~75岁,ASA分级Ⅰ~Ⅱ级,按照随机数字表法将患者分为A组和B组,58例/组,双盲观察。分别于缝合皮肤完成后通过静脉自控镇痛泵给予盐酸羟考酮注射液和氟比洛芬酯注射液镇痛。自控镇痛泵参数统一设置为:持续量2 ml/h,PCA为0.5 ml/次,锁定时间10 min。配方:A组:50 mg盐酸羟考酮注射液+0.9%生理盐水至100 ml;B组:150mg氟比洛芬酯注射液+0.9%生理盐水至100 ml。监测并记录术后6 h、12 h、24 h和48 h的患者视觉模拟疼痛(Visual Analogue Scale,VAS)评分;测定患者术后全麻拔管即刻、术后6 h、12 h、24 h和48 h的血浆IL-6、IL-10、TNF-α水平、C反应蛋白(C Reactive Protein,CRP)、T淋巴细胞亚群;测定术后24 h和48 h的膝关节主动活动度;比较镇痛期间的不良反应发生率;于出院时采用美国特种外科医院(HSS)膝关节评分标准对患者膝关节功能进行评定。结果(1)A组患者术后6 h、12 h、24 h和48 h的VAS评分低于B组,差异具有统计学意义(P0.05)。(2)两组患者术后各时间点的IL-6、IL-10和TNF-α水平的差异不具有统计学意义(P0.05)。(3)两组患者术后各时间点的CRP、CD4+、CD8+水平和CD4+/CD8+比值的差异不具有统计学意义(P0.05)。(4)两组患者术后24 h的膝关节主动活动度不具有统计学意义(P0.05),A组术后48 h的膝关节主动活动度高于B组,差异具有统计学意义(P0.05)。(5)两组患者术前美国纽约特种外科医院(HSS)评分不具有统计学意义(P0.05),A组术后HSS评分高于B组,差异具有统计学意义(P0.05)。(6)A组总不良反应发生率为8.62%;B组总应发生不良反率为10.34%,两组差异不具有统计学意义(χ2=0.100,P=0.751)。结论在老年全膝关节置换术后,盐酸羟考酮注射液的镇痛效果优于氟比洛芬酯注射液;应用盐酸羟考酮注射液的患者术后膝关节功能恢复好。
[Abstract]:Background knee joint disease is the main cause of lower limb pain and disability in the elderly. Knee arthroplasty can cure the disease. Effective control of postoperative pain, stress relief, early functional exercise is the guarantee of successful surgery. Hydroxycodone hydrochloride injection is an opioid receptor agonist with rapid effect, strong analgesic effect and little side effect. Flurbiprofen ester injection is a non-steroidal anti-inflammatory drug with antipyretic, anti-inflammatory and analgesic effects. Opioids and non-steroidal drugs are commonly used analgesic drugs after knee joint surgery. In order to find out the analgesic effect is good and the adverse reaction is low, it is more beneficial to the recovery of analgesic drugs after knee arthroplasty in the elderly, and to understand the similarities and differences between the two drugs. In this study, the analgesic effect, inflammatory reaction, stress reaction and adverse reaction of opioid and nonsteroidal flurbiprofen injection were compared after knee arthroplasty in elderly patients. Objective to observe the analgesic effect of hydroxycodone hydrochloride injection and flurbiprofen injection in elderly patients after total knee arthroplasty. To compare the advantages and disadvantages of the two methods for postoperative analgesia in elderly patients with total knee arthroplasty. Methods 116 patients with unilateral total knee arthroplasty under general anesthesia from March 1, 2016 to September 30, 2016 were selected and approved by the academic and Ethics Committee of Henan Provincial people's Hospital. The patients were randomly divided into two groups: group A and group B. After skin suture was completed, intravenous analgesia pump was used for analgesia with hydroxycodone hydrochloride injection and flurbiprofen injection respectively. The parameters of patient-controlled analgesia pump are uniformly set as follows: duration 2 ml/h,PCA is 0.5 ml/, locking time is 10 min.. Group 1: 50 mg hydroxycodone hydrochloride injection 0.9% normal saline to 100 ml;B group 0. 9% normal saline to 100 ml. group: 0. 150 mg flurbiprofen ester injection Visual analogue pain (Visual Analogue Scale,VAS) scores were monitored and recorded at 6 h, 12 h, 24 h and 48 h after operation, plasma IL-6,IL-10,TNF- 伪 levels and C-reactive protein (C Reactive Protein,CRP) T lymphocyte subsets were measured immediately after general anesthesia extubation, 24 h and 48 h after operation. The active motion of knee joint at 24 h and 48 h after operation was measured, the incidence of adverse reactions during analgesia was compared, and the knee joint function of the patients was evaluated by (HSS) knee scoring standard at the time of discharge from the United States Special surgery Hospital. Results (1) the VAS scores in group A were lower than those in group B at 6 h, 12 h, 24 h and 48 h, respectively. The difference was statistically significant (P0.05). (2). There was no significant difference in IL-6,IL-10 and TNF- 伪 levels between the two groups at each time point (P0.05). (3). There was no significant difference in CRP,CD4 CD8 level and CD4 / CD8 ratio between the two groups at different time points (P0.05). (4). There was no significant difference in the active motion of knee joint 24 hours after operation between the two groups (P0.05). The active motion of knee joint in group A was higher than that in group B at 48 hours after operation. The difference was statistically significant (P0.05). (5). The (HSS) score of the two groups was not statistically significant (P0.05). The HSS score of group A was higher than that of group B (P0.05). The incidence of total adverse reactions in group A was 8.62 and the total adverse reaction rate in group B was 10.34. There was no significant difference between the two groups (蠂 2, 0.100, P < 0. 751). Conclusion the analgesic effect of hydroxycodone hydrochloride injection is better than that of flurbiprofen injection after total knee arthroplasty in elderly patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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