不同时间点给予丁丙诺啡透皮贴剂对全髋关节置换术后镇痛效果及不良反应的临床观察

目的 探究不同时间点给予丁丙诺啡透皮贴剂对全髋关节置换术(total hip arthroplasty,THA)后镇痛效果及不良反应的影响.方法 将我院于2016年8月至2017年1月收治的90例须行THA的病人,随机分为术前48 h用药组(30例,术前48 h使用丁丙诺啡透皮贴剂)、术前24 h用药组(30例,术前24 h使用丁丙诺啡透皮贴剂)和术后即刻用药组(30例,术后立即使用丁丙诺啡透皮贴剂).三组病人术后均使用病人自控静脉镇痛泵(patient controlled intravenous analgesia,PCIA),并记录术后4、12、24、48 h以及术后3、5 d的疼痛视觉模拟量表(visual analogue scale,VAS)评分、PCIA使用量、PCIA按压次数以及使用过程中出现的不良反应.结果 术前48 h用药组有2例病人退出,最终88例病人完成本研究.经混合效应模型检验,本组病人的VAS评分、PCIA按压次数及PCIA剂量在不同时间点及不同组间均差异显著,且均随时间变化而变化.在术后4、12、24 h,术前48 h用药组的VAS评分、PCIA按压次数及PCIA使用剂量显著低于术前24 h用药组,术前24 h用药组的各项指标显著低于术后即刻用药组,差异均有统计学意义(P均<0.05);而在术后3、5 d,三组间的VAS评分比较,差异无统计学意义(P>0.05).三组病人的不良反应发生情况相比,差异无统计学意义(χ2=1.666,P=0.435).结论 THA病人术前48 h使用丁丙诺啡透皮贴剂具有较理想的术后镇痛效果,且并不会增加不良反应的发生率,具有较好的应用前景.

Postoperative analgesic efficacy and safety of transdermal Buprenorphine dosed at different time points in total hip arthroplasty

Objective To explore the postoperative analgesic effect and complications of transdermal buprenorphine dosed at different time points in patients undergoing total hip arthroplasty (THA). Methods Ninety patients receiving THA in our hospital were randomly divided into three groups: preoperative 48 h treatment group, preoperative 48 h treatment group and immediate treatment group, 30 patients in each group, which were treated with transdermal buprenorphine respectively 48 h preoperatively, 24 h preoperatively and immediately after operation. Routine therapy and patient controlled intravenous analgesia (PCIA) were used in three groups after operation. Visual analogue score (VAS), dosage and pressing times of PCIA at different time points (4 h, 12 h, 24 h, 48 h, 3 days and 5 days after operation) were recorded, while the adverse reactions were reported on a standard SAE form during the whole study. Results There were 2 cases backed out of this project in the preoperative 48 h treatment group, finally, 88 patients completed the study. The results of the mixed effects model test showed significant differences in VAS score, dosage of PCIA and pressing times of PCIA among the three groups and the different time points. VAS score, dosage of PCIA and pressing times of PCIA varied with time. VAS score, dosage of PCIA and pressing times of PCIA in preoperative 48 h treatment group were the lowest in three groups at 4, 12, 24 h postoperatively, and which were the highest in the immediate treatment group. The differences were statistically significant (P<0.05 for all). But there was no significant difference between two groups separately at 3rd and 5th day postoperatively. There was no significant difference in the occurrence of complications (χ2=1.666, P=0.435). Conclusion Preferable analgesic effect could be provided by dosing transdermal buprenorphine at 48 h preoperation, without increasing the incidence of adverse reactions.