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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (2): 293-298. doi: 10.19723/j.issn.1671-167X.2024.02.014

• 论著 • 上一篇    下一篇

前交叉韧带重建术后三种不同药物镇痛早期疗效的对比

王江静1,2,魏顺依3,敖英芳3,杨渝平3,*()   

  1. 1. 河北省沧州中西医结合医院，河北沧州 061001
    2. 河北省中西医结合骨关节病研究重点实验室(筹)，河北沧州 061001
    3. 北京大学第三医院运动医学科，北京 100191
  • 收稿日期:2022-10-17 出版日期:2024-04-18 发布日期:2024-04-10
  • 通讯作者: 杨渝平 E-mail:yyyyppvip@sina.com
  • 基金资助:
    国家科技部“科技冬奥”重点专项(2019YFF0302305);张家口市科技冬奥技术集成应用与综合示范专题(20110004D)

Comparison of the early analgesic efficacy of three different drugs after anterior cruciate ligament reconstruction

Jiangjing WANG1,2,Shunyi WEI3,Yingfang AO3,Yuping YANG3,*()   

  1. 1. Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei Province, Cangzhou 061001, Hebei, China
    2. Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Pre-paring), Cangzhou 061001, Hebei, China
    3. Department of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-10-17 Online:2024-04-18 Published:2024-04-10
  • Contact: Yuping YANG E-mail:yyyyppvip@sina.com
  • Supported by:
    Key Special Project for Science and Technology Winter Olympics of Ministry of Science and Technology of China(2019YFF0302305);the Zhangjiakou Science and Technology Winter Olympics Technology Integration Application and Comprehensive Demonstration Special Topic(20110004D)

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摘要：

目的: 比较去痛片(复方氨基比林、非那西丁片，商品名去痛片)、盐酸曲马多缓释片(商品名：奇曼丁)及盐酸哌替啶(商品名：杜冷丁)在膝关节前交叉韧带自体肌腱单束重建术后早期的止疼效果及安全性。方法: 回顾性分析2018年11月至2019年2月，北京大学第三医院连续收治的45例由同一组医师施行膝关节镜下前交叉韧带自体肌腱单束重建术患者，术后疼痛情况和使用药物镇痛情况的临床资料。采用随机区组设计，根据前交叉韧带断裂是否合并半月板损伤将患者分为两组，A组为单纯膝关节前交叉韧带重建的患者24例，B组为前交叉韧带断裂合并半月板损伤的患者21例。两组又根据患者实际使用的术后镇痛药物各分为3组，其中，A组口服去痛片4例、口服奇曼丁11例、肌肉注射(简称肌注)杜冷丁联合盐酸异丙嗪(商品名：非那根)9例；B组口服去痛片3例、口服奇曼丁10例、肌注杜冷丁联合非那根8例。术后早期，患者诉疼痛并主动要求镇痛时随机给予去痛片、奇曼丁或杜冷丁联合非那根这三种不同的止痛药物缓解疼痛，采用疼痛视觉模拟评分(visual analogue scale，VAS)评估疼痛缓解情况，并观察不良反应发生情况。结果: 患者在性别、年龄、体重指数、住院时间等基本情况上差异无统计学意义(P＞0.05)。应用三种止痛药物缓解疼痛的两组患者，在用药前及用药1 h后通过VAS评分判断结果表明，患者疼痛情况明显缓解，用药前后疼痛差异有统计学意义(P＜0.05)。对两组患者应用的三种药物进行两两比较显示，杜冷丁联合非那根组对于疼痛缓解的程度显著高于其余两种药物(P＜0.05)，用药1 h后，两组差异无统计学意义(P＞0.05)。应用杜冷丁患者易出现恶心、呕吐等副反应，但应用杜冷丁的同时使用非那根可减少副反应。在不良反应方面，仅单纯前交叉韧带重建组中应用奇曼丁组的患者出现恶心1例，其余各组患者均未出现严重的并发症及过敏反应。结论: 无论是单纯交叉韧带重建，还是合并半月板成型或缝合的交叉韧带重建，患者应用去痛片、奇曼丁、杜冷丁联合非那根这三种药物均能有效缓解疼痛，其中杜冷丁对疼痛的缓解幅度最大。应用杜冷丁的同时，合用非那根可有效减轻患者的呕吐、恶心等不良反应，增加用药安全性。

关键词: 前交叉韧带重建, 半月板损伤, 镇痛, 镇痛药, 阿片类

Abstract:

Objective: The pain-relieving effect and safety of compound aminopyrine phenacetin tablets, tramcontin (tramadol hydrochloride sustained-release tablets) and dolantin in the early stage of autologous tendon reconstruction of the anterior cruciate ligament (ACL) of the knee joint were compared. Methods: Retrospective analysis of postoperative pain and drug analgesia in 45 patients performed by the same group from November 2018 to February 2019. The random area group design was divided into two groups according to whether ACL rupture was combined with meniscal injury, group A was 24 patients with ACL reconstruction of knee joint and group B was 21 patients with ACL fracture combined with meniscus injury. The two groups were divided into three subgroups respectively according to the actual treatment of postoperative analgesic drugs received by the patients, including 4 cases of compound aminopyrine phenacetin tablets, 11 cases of oral tramcontin, 9 cases of intramuscular dolantin combined with phenergan in group A; 3 cases of compound aminopyrine phenacetin tablets, 10 cases of oral tramcontin, and 8 cases of intramuscular dolantin combined with phenergan in group B. When the early postoperative patients complain about pain and actively ask for analgesia. When the patients complained about pain after the operation and actively asked for analgesia, they were randomly given painkillers, tramcontin or dolantin combined with phenergan to relieve pain. Pain visual analogue scale (VAS) was used to evaluate pain relief and observe the occurrence of adverse reactions. Results: There were no significant dif-ferences in gender, age, body mass index, and time of hospital stay between the two groups of patients (P > 0.05). In the patients who used tramcontin and dolantin combined with phenergan to relieve pain judging by VAS score before and 1 h after taking the drug, it was found that the pain situation of the patient was significantly relieved, and the difference before and after taking the drug had statistical significance (P < 0.05). Pairwise comparisons of the three drugs applied in the two groups showed significantly greater pain relief in the dolantin combined with phenergan group than in the remaining two drugs. There was no significant difference (P > 0.05). Dolantin was prone to nausea and vomiting, but the application of phenergan was also used to reduce side effects. In terms of adverse reactions, only 1 case of nausea occurred in the tramcontin group for simple ACL reconstruction, and none of the patients in the other groups showed serious complications and allergic reactions. Conclusion: Whether in cruciate ligament reconstruction alone or combined with meniscus molding or suture, compound aminopyrine phenacetin tablets, tramcontin, dolantin combined with phenergan can effectively relieve pain. Among the three drugs, dolantin caused the largest pain relief. At the same time, the combination of phenergan effectively reduced the adverse reactions, such as vomiting and nausea, and increased the drug safety.

Key words: Anterior cruciate ligament reconstruction, Meniscus injuries, Analgesia, Analgesics, opioid

中图分类号: 

  • R687.4

表1

患者一般资料比较"

Items Group A Group B t/χ2 P
Age/years, $\bar x \pm s$ 35.85±4.25 34.25±6.26 0.035 0.972
Male/Female, n 15/9 17/4 0.067 0.759
BMI, $\bar x \pm s$ 21.76±3.25 22.17±3.42 0.043 0.966
Length of hospitalisation/d, $\bar x \pm s$ 3.75±0.62 3.52±0.46 0.266 0.791

图1

镜下重建的前交叉韧带"

图2

镜下缝合的半月板"

表2

A组患者三种止痛药物术前术后的VAS评分比较"

Group n Before taking the medicine, $\bar x \pm s$ After taking the medicine, $\bar x \pm s$ t P
Compound aminopyrine phenacetin tablets 4 5.000±0.000 2.500±0.577 8.660 0.003
Tramcontin 11 5.000±0.447 2.455±0.522 12.279 ＜0.001
Dolantin combined with phenergan 9 6.444±0.527ab 2.111±0.333 18.385 ＜0.001
F 29.186 1.631
P ＜0.001 0.220

表3

B组患者三种止痛药物术前术后的VAS评分比较"

Group n Before taking the medicine, $\bar x \pm s$ After taking the medicine, $\bar x \pm s$ t P
Compound aminopyrine phenacetin tablets 3 5.667±0.577 2.333±0.577 5.000 0.038
Tramcontin 10 5.600±0.843 2.500±0.527 11.196 ＜0.001
Dolantin combined with phenergan 8 6.750±0.463ab 2.375±0.518 23.910 ＜0.001
F 6.709 0.181
P 0.007 0.836

表4

A、B两组患者三种止痛药物用药前后VAS评分的差值比较"

Group Before taking the medicine, $\bar x \pm s$ Compound aminopyrine phenacetin tablets, $\bar x \pm s$ Tramcontin, $\bar x \pm s$ Dolantin combined with phenergan, $\bar x \pm s$ F P
Group A 5.59±0.85 2.75±0.96 2.60±0.70 4.33±0.71ab 6.217 0.008
Group B 6.95±0.86 3.75±1.26 3.00±0.89 4.43±0.53cd 4.572 0.025
t 3.379 -1.265 -1.133 -0.307
P 0.045 0.253 0.271 0.875
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ISSN 1671-167X
CN 11-4691/R
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