摘要
目的探索亚甲蓝在肋软骨采取术后疼痛管理中的有效性。方法采用前瞻性、随机对照试验, 研究时间为2023年6月至2024年3月。研究对象为接受自体肋软骨移植隆鼻手术的女性患者, 通过随机数字表法分为亚甲蓝组和对照组。亚甲蓝组在肋软骨采集前, 在第7肋软骨下缘或乳房轮廓线下的肋软骨供区皮肤和深层组织注射0.1%浓度亚甲蓝溶液5 ml。对照组患者于相同部位注射等量的生理盐水。术后管理包括常规观察监测和疼痛控制(使用口服止痛药和局部镇痛)。术后24 h采用视觉模拟量表(VAS, 0~10分, 得分越高疼痛越重)和数字评分量表(NRS, 0~10分, 得分越高疼痛越重)进行疼痛评分, 并统计口服止痛药次数;随访术后1个月内并发症发生情况, 采用自制的5分制问卷对疼痛控制效果进行患者满意度调查(分值越高患者满意度越高)。定量资料组间比较采用独立样本t检验;定性资料组间比较使用卡方检验, P<0.05为差异有统计学意义。结果共纳入112例女性患者, 亚甲蓝组56例, 年龄(35.4±5.6)岁(18~55岁);对照组56例, 年龄(36.1±6.0)岁(19~54岁)。术后24 h亚甲蓝组的口服止痛药使用量比对照组显著减少[(1.5±0.5)次比(4.7±1.2)次], 差异有统计学意义(P<0.05)。亚甲蓝组在术后24 h的VAS评分[(3.2±1.2)分比( 5.8±1.3)分]、NRS评分[(3.5±1.0)分比(6.2±1.1)分]明显低于对照组, 差异均有统计学意义(P均<0.05)。术后1个月随访, 亚甲蓝组并发症发生率显著低于对照组[10.7%(6/56)比21.4%(12/56)], 亚甲蓝组患者满意度显著高于对照组[(4.5 ± 0.6)分比(3.2 ± 0.8)分], 差异均有统计学意义(P均<0.05), 2组均未见严重不良反应。结论亚甲蓝在肋软骨移植术后具有较好的镇痛效果, 能够减少对止痛药的需求, 未见明显不良反应。
ObjectiveTo investigate the effectiveness of methylene blue in pain management after costal cartilage removal.MethodsA prospective,randomized controlled trial was conducted from June 2023 to March 2024.Female patients undergoing rhinoplasty with autologous costal cartilage transplantation were randomly divided into a methylene blue group and a control group.Before costal cartilage harvesting,patients in the methylene blue group received a 5 ml injection of 0.1%methylene blue solution into the skin and subcutaneous tissue of the costal cartilage donor site at the lower edge of the seventh costal cartilage or below the breast contour.Patients in the control group received an equal volume of normal saline injected into the same area.Postoperative management included routine observation and pain control(using oral analgesics and topical analgesia).Pain scores were assessed 24 hours after surgery using a visual analog scale(VAS,0-10 points,higher scores indicate more severe pain)and a numerical rating scale(NRS,0-10 points,higher scores indicate more severe pain),as well as the frequency of oral analgesics.Patients were followed up for postoperative complications within one month after surgery,and patient satisfaction with pain control was assessed using a self-made 5-point questionnaire(higher scores indicate greater patient satisfaction).Quantitative data were compared between groups using the independent sample t-test;qualitative data were compared between groups using the chi-square test.P<0.05 was considered statistically significant.ResultsA total of 112 female patients were enrolled.Fifty-six patients were in the methylene blue group,aged(35.4±5.6)years(range,18-55 years),and 56 patients were in the control group,aged(36.1±6.0)years(range,19-54 years).The methylene blue group had significantly lower oral analgesic use 24 hours after surgery than the control group[(1.5±0.5)times vs.(4.7±1.2)times],with statistically significant differences(P<0.05).The methylene blue group also had significantly lower VAS scores(3.2±1.2 vs.5.8±1.3)and NRS scores(3.5±1.0 vs.6.2±1.1)24 hours after surgery than the control group(P<0.05).At one-month follow-up,the incidence of postoperative complications in the methylene blue group was significantly lower than that in the control group[10.7%(6/56)vs.21.4%(12/56)].Patient satisfaction in the methylene blue group was significantly higher than that in the control group[4.5±0.6 vs.3.2±0.8].The differences were statistically significant(P<0.05).No serious adverse reactions were observed in either group.ConclusionMethylene blue has a good analgesic effect after costal cartilage transplantation,reducing the need for analgesics,and no significant adverse reactions were observed.
作者
魏清茜
何美阳
庄俊
苏学尚
张子明
胡金天
Wei Qingqian;He Meiyang;Zhuang Jun;Su Xueshang;Zhang Ziming;Hu Jintian(Department of Cleft Lip and Palate,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China;Department of Orthopedics,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Cicatrix Minimally Invasive Treatment Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)
出处
《中华整形外科杂志》
北大核心
2025年第9期939-944,共6页
Chinese Journal of Plastic Surgery
关键词
亚甲蓝
镇痛
随机对照试验
自体肋软骨移植
术后疼痛管理
视觉模拟评分法
数字评分量表
Methylene blue
Analgesia
Randomized controlled trial
Autologous costal cartilage transplantation
Postoperative pain management
Visual analogue scale
Numerical rating scale
