摘要
目的比较两种选择性环氧化酶2(COX-2)抑制剂帕瑞昔布、塞来昔布在全膝关节置换围手术期多模式镇痛中的镇痛效果。方法选择2013年1月至2014年3月首都医科大学附属北京友谊医院收治的80例行单侧全膝关节置换术(TKA)患者,随机分为塞来昔布组、帕瑞昔布组,每组40例。两组患者均进行超前镇痛及患者自控静脉镇痛,塞来昔布组在术后6 h口服塞来昔布200 mg,此后1次/12 h,200 mg/次,连续3 d;帕瑞昔布组在同时期采用肌肉注射帕瑞昔布40 mg,此后1次/12 h,40 mg/次,连续3 d。观察术后6 h、12 h、1 d、2 d、3 d两组患者静息及活动时视觉模拟量表(VAS)评分,术后第3天记录患者患侧关节最大主动、被动活动度;术后每天记录患者引流量,至引流管拔除;术后1、2、3 d记录患者睡眠满意度评分;记录术后3 d内患者恶心、呕吐、瘙痒、眩晕、尿潴留、呼吸抑制等不良反应的发生例数。VAS评分、伤口引流量、膝关节活动度、睡眠满意度,采用配对t检验进行统计学分析;药物不良反应的发生情况,采用χ2检验进行统计学分析。结果术后6 h、12 h、1 d、2 d、3 d两组患者静息时VAS评分比较差异均无统计学意义(P>0.05),术后6 h、12 h、1 d、2 d、3 d活动时的VAS评分帕瑞昔布组均小于塞来昔布组,两组比较差异有统计学意义(t=-5.586、-6.643、-6.729、-5.414、-4.718,均P<0.05);术后第3天帕瑞昔布组、塞来昔布组的膝关节主动活动度分别为(78.75±7.32)°和(74.50±6.87)°,两组比较差异有统计学意义(t=2.978,P=0.005);被动活动度分别为(96.13±6.04)°、(92.88±5.98)°,两组比较差异有统计学意义(t=2.458,P=0.019);术后1、2d帕瑞昔布组与塞来昔布组的伤口引流量比较,差异无统计学意义(t=0.191、0.401,P=0.850、0.691);术后1、2、3 d帕瑞昔布组与塞来昔布组患者睡眠满意度评分相比差异无统计学意义(t=0.192、0.745、1.903,P=0.849、0.491、0.064);帕瑞昔布�
Objective The aim of this study was to compare the analgesic effect of two selective cyclooxygenase 2（COX-2）inhibitors,celecoxib and parecoxib,in a multimodal analgesia strategy in total knee arthroplasty （TKA ） patients.Methods All patients who underwent TKA in Beijing Friendship Hospital affiliated to Capital Medical University from January 2013 to March 2014 were selected.All cases were randomized into two groups,celecoxib group and parecoxib group （40 patients respectively）.All patients received preemptive analgesia and patient-controlled intravenous analgesia （PCIA）.From 6 hours postoperatively,oral celecoxib 200 mg once per 12 hours was prescribed for 3 days in celecoxib group,while intramuscular parecoxib 40 mg once per 12 hours was used in parecoxib group.Resting and activating pain intensity was assessed by VAS scores at 6 h,12 h and on days 1,2,3 after the operation.Active and passive range of motion of the knee was record at 72 hours,while wound drainage was recorded every day until the drainage tube was removed.Sleeping satisfaction was evaluated on days 1,2,3.Incidence of side effects, such as nausea, vomiting, itching, dizziness, retention of urine and respiratory inhibition was also evaluated.χ2 test was used for statistical analysis of side effect incidence,while paired t-test was used for other data.Results There was no significant difference in the VAS scores at 6h,12h,and on days 1,2,3 when the patients were in rest condition in both groups.However,when the patients were activating,VAS scores in parecoxib group were less than celecoxib group at time of 6 h,12 h,and on days 1,2,3 （t =-5.586,-6.643,-6.729,-5.414,-4.718,all P〈0.05）.On the 3rd postoperative day,active range of motion in parecoxib group and celecoxib group was （78.75 ±7.32）°and （74.50 ±6.87）°respectively, there was significant difference between the groups （t =2.978,P =0.005 ）.Passive range of motion in parecoxib group and celecoxib group was （96.13 ±6.04）°and （92.88 ±5.98）°respecti
出处
《中华损伤与修复杂志（电子版）》
CAS
2014年第6期42-46,52,共6页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
