目的 探討圍手術期超前平衡鎮痛在肛腸手術中止痛的臨床效果。方法 回顧性分析2009年11月至2010年10月期間巴中市中醫院肛腸科123例采用腰俞穴麻醉的肛腸手術患者的臨床資料，患者被分成超前平衡鎮痛組（60例）和傳統鎮痛組（63例）2組。2組術前準備相同，術后均口服布洛芬緩釋膠囊300mg止痛，2次/d。對Ⅲ～Ⅳ度內痔及內括約肌痙攣的患者術中均常規行內括約肌松解術，對VAS評分6分以上的患者選擇使用鹽酸曲馬多注射止痛。超前平衡鎮痛組術前0.5h肌注安定10mg，口服布洛芬緩釋膠囊300mg，術中采用2%鹽酸利多卡因5ml、0.75%鹽酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理鹽水稀釋成20ml行腰俞穴麻醉并止痛，術畢肛內塞用雙氯芬酸鈉栓1枚。傳統鎮痛組術中采用2%鹽酸利多卡因5ml、0.75%鹽酸布比卡因5ml用生理鹽水稀釋成20ml行腰俞穴麻醉。比較2組術后4、6、8、12、24及48 h VAS評分、鹽酸曲馬多使用率及惡心、嘔吐及尿潴留的發生率。結果 術后4、6、8、12、24及48 h VAS評分超前平衡鎮痛組均明顯低于傳統鎮痛組（P＜0.01），術后鹽酸曲馬多使用率超前平衡鎮痛組明顯低于傳統鎮痛組（P＜0.05），惡心、嘔吐及尿潴留的發生率2組比較差異均無統計學意義（P＞0.05）。結論 圍手術期超前平衡鎮痛用于肛腸手術止痛是一種療效肯定、安全、不良反應少而又簡單易行的鎮痛方法。
ObjectiveTo observe the clinical efficacy of temperature-controlled self-heated pain relief plasters in the treatment of chronic nonspecific lower back pain, and to investigate the quality of life of patients.
MethodsPatients with chronic nonspecific lower back pain were randomly divided into a trial group and a control group. The trial group was treated with temperature-controlled self-heated pain relief plasters, while the control group was treated with meloxicam tablets for oral use. The outcome measures including the visual analogue pain scale (VAS), Japanese Orthopedic Association (JOA) scores for the management of lower back pain, and Oswestry disability index (ODI score) were collected before treatment and after 6-month follow-up. SPSS 13.0 software was used for statistical analysis.
ResultsA total of 96 patients was included (48 patients in each group), of which 68 patients (36 in the trial group and 32 in the control group) completed the treatment. The results of intention-to-treat (ITT) and per-protocol (PP) analyses showed that the total effectiveness rate of the trial group was higher than that of the control group with significant differences (all P values < 0.05). Compared with those before treatment, the JOA scores and ODI scores of the two groups were all improved after 6-month follow-up (all P values < 0.05). But no significant difference was found between the two groups in the two scores after 6-month follow-up (all P values > 0.05). During the follow-up, there were 3 and 8 patients with recurrence of lower back pain in the trial group and the control group, respectively.
ConclusionThe clinical effect of temperature-controlled self-heated pain relief plasters in the treatment of chronic nonspecific lower back pain is satisfactory, the quality of life of patients is improved obviously, and the therapy is simple, safe, inexpensive, and worthy of clinical promotion.
