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刘永刚,吴亭桦,贾震宇,张涛*.半月板手术患者围手术期曲马多使用情况分析[J].Academic Journal of Second Military Medical University ,2021,42(9):997-1002
半月板手术患者围手术期曲马多使用情况分析    点此下载全文 Fulltext
刘永刚  吴亭桦  贾震宇  张涛*
中国人民解放军南部战区总医院骨科, 广州 510010
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      目的 分析半月板手术患者围手术期曲马多使用情况,为后续合理用药提供参考。方法 回顾性分析2018年12月至2019年10月在我院接受关节镜下半月板手术的126例患者资料。根据术前1个月内是否服用曲马多将患者分为曲马多使用组(33例)与曲马多未使用组(93例),统计分析两组患者一般资料、围手术期曲马多的使用情况及随访期间药物相关不良反应的发生情况。结果 两组患者年龄、性别、BMI、第一临床诊断、麻醉方式、手术时间、手术类型、围手术期非甾体抗炎药(NSAID)使用情况差异均无统计学意义(P均>0.05)。与曲马多未使用组患者相比,曲马多使用组患者有术后3、6个月继续服用该药的风险(OR=3.294,95%CI 1.383~7.846;OR=2.795,95%CI 1.037~7.534)。术后1个月,29例单纯接受半月板手术者中,曲马多使用组继续使用率为100.0%(8/8),曲马多未使用组为76.2%(16/21),差异无统计学意义(P=0.129);74例接受膝关节手术操作<3项的患者曲马多使用率为90.5%(67/74),52例手术操作≥3项者的曲马多使用率为100.0%(52/52),差异有统计学意义(P=0.022)。曲马多使用组患者术后1个月内曲马多的处方量高于曲马多未使用组(P=0.004),但两组术后3、6个月内曲马多的处方量差异均无统计学意义(P均>0.05)。随访期间所有患者的总体不良反应发生率为11.9%(15/126),曲马多使用组胃肠道不适的发生率较曲马多未使用组高[21.2%(7/33)vs 2.2%(2/93)],差异有统计学意义(P=0.001)。同时服用曲马多和NSAID的患者胃肠道不适、消化道溃疡、过敏反应和其他不良反应的发生率均稍高于单纯服用NSAID者,但差异均无统计学意义(P均>0.05)。结论 术前服用曲马多患者术后1个月内再次服用该药的风险较术前未服用者高。膝关节镜术中接受操作项目越多的患者术后镇痛可能会依赖更多曲马多,但长期服用曲马多存在胃肠道不适等风险。
关键词:曲马多  围手术期  半月板损伤  阿片类药物
Analysis of perioperative tramadol use in patients undergoing meniscus surgery    Fulltext
LIU Yong-gang  WU Ting-hua  JIA Zhen-yu  ZHANG Tao*
Department of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou 510010, Guangdong, China
*Corresponding author
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      Objective To analyze the perioperative use of tramadol in patients undergoing meniscus surgery, so as to provide reference for subsequent rational drug use. Methods The data of 126 patients who underwent arthroscopic meniscus surgery in our hospital from Dec. 2018 to Oct. 2019 were analyzed retrospectively. According to whether tramadol was taken within 1 month before surgery, the patients were divided into tramadol group (n=33) and non-tramadol group (n=93). The general data, the use of tramadol during perioperative period and the occurrence of adverse drug reactions during follow-up were statistically analyzed. Results There were no significant differences in age, gender, body mass index, first clinical diagnosis, anesthesia methods, operation time, operation methods or perioperative non-steroidal anti-inflammatory drug (NSAID) usage between the 2 groups (all P>0.05). Compared with the non-tramadol group, patients in the tramadol group had a risk of continuing drug use 3 and 6 months after surgery (odds ratio[OR]=3.294, 95% confidence interval[CI]1.383-7.846; OR=2.795, 95% CI 1.037-7.534). One month after the operation, among the 29 patients who received meniscus operation alone, the continuous use rate of tramadol was 100.0% (8/8) in the tramadol group and 76.2% (16/21) in the non-tramadol group, with no significant difference (P=0.129); the use rate of tramadol was 90.5% (67/74) in 74 patients receiving less than 3 knee surgery procedures, and 100.0% (52/52) in 52 patients receiving no less than 3 knee surgery procedures, with significant difference (P=0.022). The prescription dose of tramadol in the tramadol group within 1 month after surgery was higher than that in the non-tramadol group (P=0.004), but there was no significant difference in the prescription dose of tramadol between the 2 groups within 3 or 6 months after surgery (both P>0.05). The overall incidence of adverse drug reactions in patients was 11.9% (15/126) during follow-up period, and the incidence of gastrointestinal distress was higher in the tramadol group than that in the non-tramadol group (21.2%[7/33] vs 2.2%[2/93]), with significant difference (P=0.001). The incidence rates of gastrointestinal distress, peptic ulcer, allergy or other adverse drug reactions in patients taking tramadol and NSAIDs at the same time were slightly higher than those in patients taking NSAIDs alone, but with no significant differences (all P>0.05). Conclusion Patients who used tramadol preoperatively have a higher risk of reusing tramadol within 1 month of surgery compared with non-users. Patients receiving more intraoperative procedures during knee arthroscopy may rely more on tramadol for postoperative analgesia, but long-term use of tramadol may lead to adverse drug reactions such as gastrointestinal distress.
Keywords:tramadol  perioperative period  meniscus injury  opioids
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