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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2020, Vol. 15 ›› Issue (05) : 383 -388. doi: 10.3877/cma.j.issn.1673-9450.2020.05.010

所属专题： 文献；

论著

超前镇痛在经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折术中的镇痛效果及安全性
薛广1, 杨新明2,†(), 张瑛2   
  1. 1. 075000　张家口，河北北方学院研究生学院
    2. 075000　张家口，河北北方学院附属第一医院骨科
  • 收稿日期:2020-07-15 出版日期:2020-10-01
  • 通信作者: 杨新明
  • 基金资助:
    2021年度河北省卫健委医学科研课题(20211019); 2018年张家口高层次创新团队建设项目(2018-04)

Effect of preemptive analgesia in the treatment of senile osteoporotic vertebral compressed fracture by percutaneous kyphoplasty

Guang Xue1, Xinming Yang2,†(), Ying Zhang2   

  1. 1. Graduate School of Hebei North University, Zhangjiakou 075000, China
    2. Department of Orthopaedics, First Affiliated Hospital of HeBei North University, Zhangjiakou 075000, China
  • Received:2020-07-15 Published:2020-10-01
  • Corresponding author: Xinming Yang
  • About author:
    Corresponding author: Yang Xinming, Email:
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引用本文：

薛广, 杨新明, 张瑛. 超前镇痛在经皮椎体后凸成形术治疗老年骨质疏松性椎体压缩骨折术中的镇痛效果及安全性[J]. 中华损伤与修复杂志(电子版), 2020, 15(05): 383-388.

Guang Xue, Xinming Yang, Ying Zhang. Effect of preemptive analgesia in the treatment of senile osteoporotic vertebral compressed fracture by percutaneous kyphoplasty[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(05): 383-388.

目的

评价超前镇痛(PA)模式在经皮椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩骨折(OVCF)术中的镇痛效果及安全性。

方法

选择2018年1月至2019年12月河北北方学院附属第一医院收治的符合纳入标准的患者84例，按随机数字表法分为PA组和对照组，2组患者均行PKP手术，经皮穿刺、球囊扩张后向病椎内部灌注骨水泥，PA组于手术开始前15 min肌肉注射地佐辛注射液10 mg，对照组于术前不予特殊处理。记录2组患者手术开始前(T1)、穿刺套管针穿刺时(T2)、骨水泥推注时(T3)、术后24 h(T4)4个时间点的疼痛视觉模拟评分(VAS)评分及2组术中麻醉药使用剂量；记录2组T1、T2、T3时间点患者心率、血压变化情况及T1时间点至T4时间点内药物不良反应情况；患者对术中疼痛控制效果满意度。数据比较采用t检验和卡方检验。

结果

2组T1时间点VAS评分分别为(6.9±0.3)、(6.8±0.4)分，差异无统计学意义(t＝1.36，P＝0.17)；2组T4时间点VAS评分分别为(2.2±0.3)、(2.4±0.2)分，差异无统计学意义(t＝1.98，P＝0.21)；T2时间点VAS评分分别为(2.5±0.8)、(3.7±0.9)分，差异有统计学意义(t＝3.23，P<0.05)；T3时间点VAS评分分别为(2.4±0.6)、(3.6±0.6)分，差异有统计学意义(t＝3.86，P<0.05)；术中麻醉药使用剂量PA组[(9.1±1.1) mL]明显少于对照组[(16.6±1.4) mL]，差异有统计学意义(t＝4.47，P<0.05)；2组T1时间点心率分别为(92±8)、(94±9)次/min，血压(1 528/907)、(1 559/918) mmHg(1 mmHg＝0.133 kPa)，差异均无统计学意义(P值均大于0.05)，T2、T3时间点比较差异均有统计学意义(P值均小于0.05)；从T1时间点至T4时间点内2组间的药物不良反应比较差异均无统计学意义(P值均大于0.05)，患者对术中疼痛控制效果的满意度PA组明显高于对照组，差异有统计学意义(χ2＝5.48, P<0.05)。

结论

在PKP治疗OVCF患者手术过程中实施PA是安全、可行的，具有较好的镇痛效果且患者满意度高。

关键词: 椎体成形术, 骨质疏松, 骨质疏松性骨折, 老年人, 超前镇痛, 疗效
Objective

To evaluate the analgesic effect and safety of preemptive analgesia(PA) model in the treatment of senile osteoporosis vertebra compressed fracture(OVCF) with percutaneous kyphoplasty(PKP).

Methods

A total of 84 patients who conform to the inclusion criteria and were admitted to First Affiliated Hospital of HeBei North University from January 2018 to December 2019 were selected and randomly divided into the PA group and the control group accerding to the random toble method. Both of which were treated with PKP, the pathologic vertebra was injected into bone cement, after via percutaneous puncture and the interventional balloon dilation. The PA group was intramuscular injected with 10 mg Dezocine injection 15 min before the operation, while the control group was not given special treatment before the operation. The visual analogue scale(VAS) score of 4 time points, before operation (T1), trocar puncture (T2), bone cement injection (T3), and 24 h after operation (T4) were recorded in the 2 groups. Recorded the dosage of anesthetics used in the two groups during the operation, and recorded the changes in heart rate and blood pressure of patients at T1, T2 and T3 time points. Adverse drug reactions from T1 time point to T4 time after surgery were recorded. Patients′ satisfaction with the effect of intraoperative pain control were recorded, too. The data was analyzed by t test and chi-square test.

Results

The VAS scores of the two groups at T1 time point were (6.9±0.3), (6.8±0.4) points, and the difference was not statistically significant (t=1.36, P=0.17); the VAS scores of the two groups at T4 time point were (2.2±0.3), (2.4±0.2) points, the difference was not statistically significant (t=1.98, P=0.21); the VAS scores of the two groups at T2 time point were (2.5±0.8), (3.7±0.9) points, the difference was statistically significant (t=3.23, P<0.05); the VAS scores of the two groups at T3 time point were (2.4±0.6), (3.6±0.6) points, the difference was statistically significant (t=3.86, P<0.05). Intraoperative anesthetic dose of PA group(9.1±1.1)mL was significantly lower than that in the control group[(16.6±1.4) mL] (t=4.47, P<0.05). There was no statistically significant difference in heart rate [(92±8), (94±9) times/min] and blood pressure[(1 528/907), (1 559/918) mmHg(1 mmHg=0.133 kPa)] between the two groups at T1 time point (with P values above 0.05), and there were statistically significant differences at T2 and T3 time point (with P values below 0.05). There was no difference in the adverse drug reactions between the two groups from T1 time point to T4 time after surgery (P>0.05). Patients′ satisfaction with the effect of intraoperative pain control was significantly higher in the PA group than in the control group with a difference (χ2=5.48, P<0.05).

Conclusion

It is safe and feasible to perform PA during the operation of PKP in patients with OVCF with good analgesic effect and high patient satisfaction.

Key words: Kyphoplasty, Osteoporosis, Osteoporotic fractures, Aged, Preemptive Analgesia, Curative effect
表1 2组OVCF患者一般情况比较(±s)
组别 例数 年龄(岁) 性别(男/女) 体重(kg) 骨密度(g/cm2) 术前VAS评分(分) 手术时间(min)
PA组 42 73.85±6.07 13/29 62.67±4.18 0.712±0.024 6.9±0.3 38.67±4.11
对照组 42 72.45±6.11 11/31 62.93±4.32 0.717±0.035 6.8±0.4 43.69±3.89
χ2/t值   1.21 0.23 0.78 0.40 1.54 1.17
P值   0.23 0.62 0.44 0.68 0.21 0.24
表2 2组OVCF患者骨折椎体分布情况比较(例)
组别 例数 T8 T9 T10 T11 T12 L1 L2 L3 L4
PA组 42 1 2 3 5 10 15 3 2 1
对照组 42 1 2 2 4 11 15 4 2 1
χ2值   0.00 0.00 0.21 0.12 0.63 0.00 0.15 0.00 0.00
P值   >0.05 >0.05 0.64 0.72 0.80 >0.05 0.69 >0.05 >0.05
表3 2组OVCF患者不同时间点疼痛VAS评分及麻醉药使用剂量比较(±s)
组别 例数 T1(分) T2(分) T3(分) T4(分) 2%利多卡因(mL)
PA组 42 6.9±0.3 2.5±0.8 2.4±0.6 2.2±0.3 9.1±1.1
对照组 42 6.8±0.4 3.7±0.9 3.6±0.6 2.4±0.2 16.6±1.4
t值   1.36 3.23 3.86 1.98 4.47
P值   0.17 <0.05 <0.05 0.21 <0.05
表4 2组OVCF患者术中心率、血压比较(±s)
组别 例数 心率(次/min) 收缩压/舒张压(mmHg)
T1 T2 T3 T1 T2 T3
PA组 42 92±8 82±7 83±8 152±8/90±7 153±3/85±8 153±6/85±9
对照组 42 94±9 108±5 109±6 155±9/91±8 165±6/95±4 169±4/95±5
t值   0.47 3.33 3.51 1.68 3.90 3.98
P值   0.64 <0.05 <0.05 0.11 <0.05 <0.05
表5 2组患者术后不良反应及满意度比较[例(%)]
组别 例数 头晕 恶心呕吐 嗜睡 满意度
PA组 42 13(30.95) 11(26.19) 2(4.75) 40(95.23)
对照组 42 12(28.57) 9(21.48) 3(7.14) 26(61.90)
χ2值   0.57 0.26 0.21 13.85
P值   0.81 0.60 0.64 <0.05
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