中国临床药理学杂志

左旋布比卡因联合氨甲环酸对腰椎后路融合术后镇痛的临床研究

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付太冉 ^1a , 夏宗玲 ^1b , 施晓婷 ^1c , 高操 ^1a

中国临床药理学杂志 | 临床与基础桥接研究 2026,42(9): 1244-1250

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中国临床药理学杂志 |临床与基础桥接研究 2026 , 42 (9) : 1244 -1250

左旋布比卡因联合氨甲环酸对腰椎后路融合术后镇痛的临床研究

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付太冉^1a, 夏宗玲^1b, 施晓婷^1c, 高操^1a

作者信息

^1a.常州市第一人民医院，麻醉科，江苏常州 213000

^1b.常州市第一人民医院，药剂科，江苏常州 213000

^1c.常州市第一人民医院，重症监护室，江苏常州 213000

通讯作者:

高操，副主任医师，硕士生导师 MP: 13801507929 E-mail: gjzszg@hotmail.com

作者简介:

付太冉（1991-），男，硕士研究生，主治医师，主要从事麻醉方面的临床工作和研究

Clinical trial of levobupivacaine combined with tranexamic acid after posterior lumbar fusion

Tai-ran FU^1a, Zong-ling XIA^1b, Xiao-ting SHI^1c, Cao GAO^1a

Affiliations

^1a.Department of Anesthesiology, Changzhou First People’s Hospital, Changzhou 213000, Jiangsu Province, China

^1b.Department of Pharmacy, Changzhou First People’s Hospital, Changzhou 213000, Jiangsu Province, China

^1c.Intensive Care Unit, Changzhou First People’s Hospital, Changzhou 213000, Jiangsu Province, China

出版时间: 2026-05-17 doi: 10.13699/j.cnki.1001-6821.2026.09.008

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摘要

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目的

观察左旋布比卡因注射液联合氨甲环酸注射液局部浸润对腰椎后路椎间融合术患者的临床疗效和安全性。

方法

将我院行腰椎后路椎间融合术患者根据术后切口局部浸润用药方案分为试验组和对照组。对照组用生理盐水20 mL局部浸润，试验组用含左旋布比卡因注射液（浓度为0.25%，即37.5 mg稀释至15 mL）及氨甲环酸注射液（浓度为10%，即0.2 g稀释至5 mL）的混合液20 mL局部浸润。比较2组患者术后2、6、12、24、48 h的静息与活动视觉模拟评分（VAS），术后补救镇痛率，术后24 h血清炎症因子、应激指标和术后恢复指标，并进行安全性评价。

结果

本研究最终纳入92例患者，对照组48例、试验组44例。治疗后，对照组与试验组术后48 h静息视觉模拟量表（VAS）评分分别为（1.75±0.44）和（1.55±0.50）分，活动VAS评分分别为（2.54±0.50）和（2.32±0.47）分；术后24 h白介素6（IL-6）分别为（57.02±5.15）和（54.23±4.52）pg·mL^-1，血清肿瘤坏死因子-α（TNF-α）分别为（34.12±5.40）和（30.88±5.13）pg·mL^-1，中枢神经特异蛋白（S100β）分别为（110.78±9.66）和（104.13±10.54）pg·mL^-1，血清皮质醇（Cor）分别为（95.87±14.69）和（89.43±13.73）ng·mL^-1，去甲肾上腺素（NE）分别为（369.43±51.81）和（342.86±48.13）ng·mL^-1，晚期氧化蛋白产物（AOPP）分别为（66.19±12.36）和（58.97±11.74）μmol·L^-1；术后0~11 h补救镇痛率分别为33.33%（16例/48例）和13.64%（6例/44例），12~24 h补救镇痛率分别为22.92%（11例/48例）和6.82%（3例/48例）；术后首次下床活动时间分别为（2.79±0.62）和（2.48±0.55）d，首次排气时间分别为（30.79±5.35）和（28.02±5.20）h，住院时间分别为（7.38±1.44）和（6.66±1.29）d，术后3 d QoR-15评分分别为（116.69±7.42）和（121.66±8.72）分，2组患者的上述指标比较，在统计学上差异均有统计学意义（均P<0.05）。试验组的药物不良反应包括恶心呕吐、发热和尿潴留，对照组包括发热、恶心呕吐、尿潴留和皮肤瘙痒。试验组和对照组的药物不良反应总发生率分别为9.09%（4例/44例）和14.58%（7例/48例）；并发症包括切口愈合不良，发生率分别为2.27%（1例/44例）和2.08%（1例/48例），2组的药物不良反应总发生率和并发症发生率比较，在统计学上差异均无统计学意义（P>0.05，P<0.01）。

结论

在腰椎后路椎间融合术中，用左旋布比卡因注射液联合氨甲环酸注射液进行切口周围局部浸润能提供更有效且持久的术后镇痛，显著减轻机体的炎症与应激反应，并促进患者术后早期康复，缩短住院时间，且不增加并发症风险。

关键词

左旋布比卡因注射液 / 氨甲环酸注射液 / 腰椎后路椎间融合术 / 术后镇痛 / 局部浸润 / 加速康复外科

Abstract

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Objective

To observe the clinical efficacy and safety of local infiltration of levobupivacaine injection combined with tranexamic acid injection in patients undergoing posterior lumbar interbody fusion.

Methods

Patients undergoing posterior lumbar interbody fusion surgery in our hospital were divided into treatment group and control group based on the local infiltration medication regimen postoperatively. The control group received 20 mL of normal saline for local infiltration, and the treatment group received 20 mL of a mixed solution containing levobupivacaine injection (concentration 0.25%, 37.5 mg diluted to 15 mL) and tranexamic acid injection (concentration 10%, 0.2 g diluted to 5 mL). The two groups were compared in terms of visual analogue scale (VAS) scores at rest and during activity at 2, 6, 12, 24 and 48 hours postoperatively, postoperative rescue analgesia rate, serum inflammatory markers, stress indicators at 24 hours postoperatively, postoperative recovery indicators, and safety evaluation was conducted.

Results

A total of 92 patients were finally enrolled, with 48 in control group and 44 in treatment group. After treatment, the resting VAS scores at 48 hours postoperatively in control group and treatment group were (1.75±0.44) and (1.55±0.50) points, respectively; the activity VAS scores were (2.54±0.50) and (2.32±0.47) points, respectively; the interleukin-6 (IL-6) levels at 24 hours postoperatively were (57.02±5.15) and (54.23±4.52) pg·mL^-1, respectively; the tumor necrosis factor-α (TNF-α) levels were (34.12±5.40) and (30.88±5.13) pg·mL^-1, respectively; the S100 calcium-binding protein B (S100β) levels were (110.78±9.66) and (104.13±10.54) pg·mL^-1, respectively; the serum cortisol (Cor) levels were (95.87±14.69) and (89.43±13.73) ng·mL^-1, respectively; the norepinephrine (NE) levels were (369.43±51.81) and (342.86±48.13) ng·mL^-1, respectively; the advanced oxidation protein products (AOPP) levels were (66.19±12.36) and (58.97±11.74) μmol·L^-1, respectively; the rescue analgesia rates at 0-11 h postoperatively were 33.33% (16 cases/48 cases) and 13.64% (6 cases /44 cases), respectively; and at 12-24 h were 22.92% (11 cases /48 cases) and 6.82% (3 cases /44 cases), respectively; the first ambulation time were (2.79±0.62) and (2.48±0.55) days, the first flatus time were (30.79±5.35) and (28.02±5.20) hours, the hospital stay were (7.38±1.44) and (6.66±1.29) days, respectively; and the quality of recovery-15 (QoR-15) score at postoperative day 3 were (116.69±7.42) and (121.66±8.72) points, respectively; statistically significant differences were observed in all the above indicators between the two groups (all P<0.05). The adverse drug reactions in treatment group included nausea and vomiting, fever and urinary retention, while those in control group included fever, nausea and vomiting, urinary retention and pruritus. The overall incidence of adverse drug reactions in treatment group and control group were 9.09% (4 cases/44 cases) and 14.58% (7 cases/48 cases), respectively; complications included poor wound healing, with incidence rates of 2.27% (1 case/44 cases) and 2.08% (1 case/48 cases), respectively, with no statistically significant differences between the groups (P>0.05, P>0.01).

Conclusion

In posterior lumbar interbody fusion, local infiltration of levobupivacaine injection combined with tranexamic acid injection around the incision provides more effective and sustained postoperative analgesia, significantly reduces systemic inflammation and stress response, promotes early postoperative rehabilitation, shortens hospital stay, and does not increase the risk of complications.

Key words

levobupivacaine injection / tranexamic acid injection / posterior lumbar interbody fusion / postoperative analgesia / local infiltration / enhanced recovery after surgery

引用本文

付太冉, 夏宗玲, 施晓婷, 高操. 左旋布比卡因联合氨甲环酸对腰椎后路融合术后镇痛的临床研究. 中国临床药理学杂志, 2026 , 42 (9) : 1244 -1250 . DOI: 10.13699/j.cnki.1001-6821.2026.09.008

Tai-ran FU, Zong-ling XIA, Xiao-ting SHI, Cao GAO. Clinical trial of levobupivacaine combined with tranexamic acid after posterior lumbar fusion[J]. Chinese Journal of Clinical Pharmacology, 2026 , 42 (9) : 1244 -1250 . DOI: 10.13699/j.cnki.1001-6821.2026.09.008

基金

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2024年度医院药学高质量发展研究项目专项基金资助项目(NIHAZX202415)

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2026年第42卷第9期

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文章信息

doi: 10.13699/j.cnki.1001-6821.2026.09.008

接收时间：2026-03-14
首发时间：2026-08-06
出版时间：2026-05-17

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收稿日期：2026-03-14

基金

2024年度医院药学高质量发展研究项目专项基金资助项目(NIHAZX202415)

作者信息

^1a.常州市第一人民医院，麻醉科，江苏常州 213000

^1b.常州市第一人民医院，药剂科，江苏常州 213000

^1c.常州市第一人民医院，重症监护室，江苏常州 213000

通讯作者:

高操，副主任医师，硕士生导师 MP: 13801507929 E-mail: gjzszg@hotmail.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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