塞来昔布在全髋关节置换手术超前镇痛中的应用价值分析

目的观察塞来昔布在全髋关节置换手术进行超前镇痛的临床应用价值,为全髋关节置换手术围手术期镇痛优化提供依据。方法选择2015年3月至2018年3月在中国医科大学附属第一医院进行全髋关节置换手术的患者,共74例,随机分为观察组及对照组,每组37例。观察组口服塞来昔布3 d后进行手术,在手术后6 h继续给予口服塞来昔布3 d,术后同时给予静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA)泵;对照组术前不给予镇痛药物,术后给予PCIA镇痛。观察两组不同时间点疼痛视觉模拟评分(Visual analogue scale,VAS)变化,记录PCIA按压次数,观察手术前后血清COX-2、PGE2水平变化及镇痛药相关不良反应。结果观察组术后离床时间早于对照组(P<0.05),观察组VAS评分在术后24 h、36 h及48 h低于对照组(P<0.05),观察组PCIA按压次数明显少于对照组(3.27±1.09)次vs.(9.28±3.51)次,P<0.05]。观察组病人镇痛泵使用量明显低于对照组(112.09±29.87)mg vs.(154.21±64.92)mg],差异有统计学意义(P<0.001)。与对照组比较,术后2 h观察组COX-2及PGE2水平均较低(P<0.05)。观察组与对照组术后烧心、恶心呕吐及眩晕等不良反应发生率比较差异无统计学意义(P>0.05)。结论塞来昔布在全髋关节置换手术进行超前镇痛可以减少静脉止痛药应用剂量,优化镇痛模式。

Application value of celecoxib in preemptive analgesia of total hip replacement

Objective To observe the value of celecoxib in preemptive analgesia of total hip replacement and provide experimental basis for optimized analgesia.Methods Seventy-four patients who need total hip replacement from March 2015 to March 2018 in the First Hospital of China Medical University were divided into observation group and control group randomly,37 cases respectively.Celecoxib was orally administrated at 3 d before operation and 6 hafter operation for 3 d in observation group,and PCIA was used at the same time.In control group,PCIA was used after operation.VAS score was recorded at different time points after operation,and the PCIA press times were recorded too.The levels of COX-2 and PGE2 wererecorded before and after operation.Analgesics-related adverse reactions were recorded.Results The out-of-bed time in observation group was shorter than in control group(P<0.05),and the VAS score was lower than that in control group at 24 h,36 h and 48 h after operation(P<0.05).The PCIA press times in observation group werefewer than those in control group(3.27±1.09)mg vs.(9.28±3.51),P<0.05],and the PCIA pump consumption was less than that in control group respectively(112.09±29.87)mg vs.(154.21±64.92)mg,P<0.001].The levels of serum COX-2 and PGE2 in observation group was lower than those in control group at 2 h after operation(P<0.05).There were no significant difference in the incidence rates of heartburn,nausea,vomiting and dizziness between the two groups(P>0.05).Conclusion Celecoxibcan decrease the dose of intravenous analgesics in preemptive analgesia of total hip replacement and optimize the analgesia mode.