美洛昔康针剂用于骨科术后镇痛效果及安全性研究

摘要

目的 研究美洛昔康针剂用于骨科术后镇痛的效果及安全性.方法 :在上海4家不同医院骨科各随机选取40例手术患者共160例,使用美洛昔康针剂进行术后镇痛.入组患者术后1h接受美洛昔康针剂15mg肌注,术后24h接受15mg肌注.对镇痛疗效不佳者予以枸橼酸芬太尼注射液补充镇痛.采用视觉模拟评分(VAS)在术后1h(用药前)、2h、4h、8h、12h、24h、48h分别评估疼痛程度,并记录补充镇痛药物枸橼酸芬太尼的用量.术前及术后1周行血常规、肝肾功能、心电图检查,观察有无与药物相关的不良事件产生.结果 :入组男性患者105例(65.63%),女性患者55例(34.37%),平均年龄46.36岁(21-65岁).接受大手术85例(53.1%),中手术者42例(26.3%),小手术者33例(20.6%).用药前(术后1h)VAS平均评分为8.3,用药后各时间点VAS平均评分分别为7.8、7.1、6.8,5.5、3.7、2.4,提示美洛昔康针剂术后镇痛总体疗效满意.按手术大小分类观察各时间点VAS评分,并比较各组疼痛缓解率,可见美洛昔康针剂对于不同类型的骨科手术均有较好的镇痛疗效,但对大、中型骨科手术,还需加用中枢性阿片类镇痛药物加强镇痛效果.用药前后血常规、肝肾功能和心电图结果的差异无统计学意义,提示美洛昔康针剂临床安全性良好.结论 :使用美洛昔康针剂可有效缓解骨科术后疼痛,并能减少中枢性镇痛药的使用剂量,且无明显不良反应,是一种有效的骨科术后镇痛药物.%Objective To study the effect and safety of post-operative analgesic with meloxicam (Mobic) injection. Methods Fourty patients each, 160 in all, were chosen randomly from 4 hospitals in Shanghai. Meloxicam injection was applied to relieve pain for those patients after orthopsadic surgery. Meloxicam injection of 15 mg was administered one hour and 24 hours postoperation by intramuscular respectively. Fentanyl citrate was added in those whose pain was not relieved sufficiently. Visual Analog Scale (VAS) was adopted to evaluate pain intensity at 1st (before injection), 2nd, 4th, 8th, 12th, 24th and 48th hour post-operatively. The dose of fentanyl citrate used, if added, was also recorded. Blood cell analysis, liver and kidney functions,ECG were performed before and one week after surgery. Any drug-related adverse event was observed. Results There were 105males (65. 63％ ) and 55 females(34. 37 ％) recruited in the study. The average age was 46. 36 years(21-65 years). Among them,85( 53. 1 ％) received major surgery, 42(26. 3％) moderate surgery, 33(20. 6％) minor surgery. The average VAS score at one hour post-operation (before meloxicam injection) was 8. 3, and 7. 8, 7. 1, 6. 8, 5. 5, 3. 7, 2. 4 at other check points respectively.The VAS score was obviously reduced after the application of meloxicam injection, which indicates that meloxicam injection is effective in pain relief for most orthopeadic patients who had received surgery. VAS .scores recorded in 3 different groups divided by the invasive intensity of surgeries were compared to evaluate the efficacy of pain relief. It was showed that meloxicam injection was able to relieve pain in all groups, yet fentanyl citrate was needed in some cases who received moderate to major surgery. The lab results of blood cell analysis, liver and kidney functions and ECG showed no statistical difference before and after injection, which means meloxicam injection is safe for patients received orthpeadic surgeries. Conclusions Meloxicam injection is effident in pain relief after orthopaedic surgery. It reduces the usage and does of central analgesics and no obvious adverse events were observed during the study. In a word, it is an effective post-operative analgesic for orthopeadic patients.