鹽酸羥考酮注射液和氟比洛芬酯注射液用于老年膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的效果比較
發(fā)布時間：2018-09-12 09:22
【摘要】：背景膝關(guān)節(jié)疾病是引起老年人下肢疼痛和致殘的主要原因,膝關(guān)節(jié)置換手術(shù)可根治疾病。有效地控制術(shù)后疼痛,減輕應(yīng)激反應(yīng),及早功能鍛煉是手術(shù)成功的保證。鹽酸羥考酮注射液是阿片受體激動劑,起效迅速,鎮(zhèn)痛作用強,副作用小。氟比洛芬酯注射液是非甾體類抗炎藥,具有解熱、抗炎、鎮(zhèn)痛等作用。阿片類藥物和非甾體類藥物是膝關(guān)節(jié)手術(shù)后常用的鎮(zhèn)痛藥,為尋找鎮(zhèn)痛效果好、不良反應(yīng)低,更有利于老年膝關(guān)節(jié)置換術(shù)后恢復(fù)的鎮(zhèn)痛用藥,了解兩藥的相同和不同之處,本研究選擇阿片類藥物鹽酸羥考酮注射液和非甾體類藥物氟比洛芬酯注射液用于老年膝關(guān)節(jié)置換術(shù)后,對其鎮(zhèn)痛效果、炎癥反應(yīng)、應(yīng)激反應(yīng)及不良反應(yīng)等方面進(jìn)行對比觀察。目的觀察鹽酸羥考酮注射液和氟比洛芬酯注射液在老年全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的效果,對患者應(yīng)激反應(yīng)和炎癥反應(yīng)的影響以及不良反應(yīng);比較二者用于老年患者全膝關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的優(yōu)缺點。方法經(jīng)河南省人民醫(yī)院學(xué)術(shù)與倫理委員會批準(zhǔn),選擇該院2016年3月1日-2016年9月30日期間行全身麻醉下單側(cè)全膝關(guān)節(jié)置換術(shù)的患者116例,年齡60~75歲,ASA分級Ⅰ~Ⅱ級,按照隨機數(shù)字表法將患者分為A組和B組,58例/組,雙盲觀察。分別于縫合皮膚完成后通過靜脈自控鎮(zhèn)痛泵給予鹽酸羥考酮注射液和氟比洛芬酯注射液鎮(zhèn)痛。自控鎮(zhèn)痛泵參數(shù)統(tǒng)一設(shè)置為:持續(xù)量2 ml/h,PCA為0.5 ml/次,鎖定時間10 min。配方:A組:50 mg鹽酸羥考酮注射液+0.9%生理鹽水至100 ml;B組:150mg氟比洛芬酯注射液+0.9%生理鹽水至100 ml。監(jiān)測并記錄術(shù)后6 h、12 h、24 h和48 h的患者視覺模擬疼痛(Visual Analogue Scale,VAS)評分;測定患者術(shù)后全麻拔管即刻、術(shù)后6 h、12 h、24 h和48 h的血漿IL-6、IL-10、TNF-α水平、C反應(yīng)蛋白(C Reactive Protein,CRP)、T淋巴細(xì)胞亞群;測定術(shù)后24 h和48 h的膝關(guān)節(jié)主動活動度;比較鎮(zhèn)痛期間的不良反應(yīng)發(fā)生率;于出院時采用美國特種外科醫(yī)院(HSS)膝關(guān)節(jié)評分標(biāo)準(zhǔn)對患者膝關(guān)節(jié)功能進(jìn)行評定。結(jié)果(1)A組患者術(shù)后6 h、12 h、24 h和48 h的VAS評分低于B組,差異具有統(tǒng)計學(xué)意義(P0.05)。(2)兩組患者術(shù)后各時間點的IL-6、IL-10和TNF-α水平的差異不具有統(tǒng)計學(xué)意義(P0.05)。(3)兩組患者術(shù)后各時間點的CRP、CD4+、CD8+水平和CD4+/CD8+比值的差異不具有統(tǒng)計學(xué)意義(P0.05)。(4)兩組患者術(shù)后24 h的膝關(guān)節(jié)主動活動度不具有統(tǒng)計學(xué)意義(P0.05),A組術(shù)后48 h的膝關(guān)節(jié)主動活動度高于B組,差異具有統(tǒng)計學(xué)意義(P0.05)。(5)兩組患者術(shù)前美國紐約特種外科醫(yī)院(HSS)評分不具有統(tǒng)計學(xué)意義(P0.05),A組術(shù)后HSS評分高于B組,差異具有統(tǒng)計學(xué)意義(P0.05)。(6)A組總不良反應(yīng)發(fā)生率為8.62%;B組總應(yīng)發(fā)生不良反率為10.34%,兩組差異不具有統(tǒng)計學(xué)意義(χ2=0.100,P=0.751)。結(jié)論在老年全膝關(guān)節(jié)置換術(shù)后,鹽酸羥考酮注射液的鎮(zhèn)痛效果優(yōu)于氟比洛芬酯注射液;應(yīng)用鹽酸羥考酮注射液的患者術(shù)后膝關(guān)節(jié)功能恢復(fù)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- 偽 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- 偽 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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
本文編號：2238581
[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- 偽 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- 偽 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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
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