摘要
目的探究帕瑞昔布钠超前镇痛对换膝骨关节炎人工膝关节置换患者术后镇痛、炎症因子及认知功能的影响。方法选取2017年1月—2019年9月成都医学院第二附属医院就诊的膝骨关节炎患者共100例,全部行人工膝关节置换术,随机将其分为实验组和对照组,每组50例。对照组不予以任何超前镇痛,实验组麻醉前静脉注射帕瑞昔布钠40 mg,两组术后均静脉注射舒芬太尼自控镇痛。分别于术前1 h、术后6 h、术后12 h、术后24 h、术后48 h采用视觉模拟评分(VAS)进行疼痛评分;HSS膝关节功能评分法对膝关节功能进行评分;简易智力状态检查量表(MMSE)进行认知功能评分。酶联免疫吸附试验(ELISA)测定各时间点血清中IL-6、IL-10、TNF-α的表达水平。结果两组患者术后VAS评分随着时间延长逐渐降低,其中实验组在术后6 h、12 h、24 h及48 h评分与对照组比较,差异有统计学意义(P<0.05),实验组低于对照组;两组HSS膝关节评分随着时间延长逐渐升高,实验组在术后12 h、24 h及48 h评分与对照组比较,差异有统计学意义(P<0.05),实验组低于对照组;术后两组患者的IL-6、TNF-α水平均升高,但实验组在术后各时间点的水平较对照组低(P<0.05);两组患者术后IL-10水平均降低,但实验组在术后各时间点的水平较对照组高(P<0.05)。两组术后早期认知功能评分均下降,但实验组术后6 h、12 h、24 h及48 h评分较对照组高(P<0.05)。实验组的不良反应总发生率为6.0%,低于对照组的不良反应总发生率16.0%。结论帕瑞昔布钠超前镇痛对实施人工膝关节置换术的膝骨关节炎患者的术后镇痛效果良好,术后炎症因子水平降低,抗炎因子水平升高,炎症反应减少,有效保护患者认知功能,且不良反应少,可推广应用于临床。
Objective To investigate the clinical efficacy of preemptive analgesia with parecoxib sodium in the treatment of postoperative analgesia of knee osteoarthritis with artificial knee joint replacement and the levels of IL-6,IL-10 and TNFαin serum.Methods Totally 100 patients with knee osteoarthritis from January 2017 to September 2019 were collected.All patients underwent artificial knee arthroplasty.The patients were randomly divided into experimental group and control group,50 cases in each group.The control group did not undergo any preemptive analgesia.The experimental group received intravenous injection of parecoxib sodium 40 mg before anesthesia.Both groups received intravenous sufentanil for controlled analgesia.Pain scores were performed using VAS and MMSE for cognitive function scoring in 1 h before surgery,6 h after surgery,12 h after surgery,24 h after surgery,and 48 h after surgery.The expression levels of IL-6,IL-10 and TNFαin serum were determined by ELISA.Results VAS scores of patients in the two groups gradually decreased with the extension of time,and the scores in the experimental group were lower than those in the control group at the 6 h,12 h,24 h,and 48 h after surgery,with statistically significant differences(P<0.05).The HSS knee score gradually increased with the extension of time,and the scores of the experimental group were lower than those of the control group at 12 h,24 h and 48 h after surgery,with statistically significant differences(P<0.05).The levels of IL-6 and TNFαwere increased in both groups after surgery,but were lower in the experimental group at the 6 h,12 h,24 h,and 48h after surgery,with statistically significant differences(P<0.05).After the operation,IL-10 concentration in both groups was decreased,and it was higher in the experimental group at the 6 h,12 h,24 h,and 48 h after the operation,with statistically significant difference(P<0.05).In the early postoperative period,cognitive function scores of both groups decreased,but those of the experimental group were high
作者
刘选泽
肖国庆
钟喜红
程劲
Xuan-ze Liu;Guo-qing Xiao;Xi-hong Zhong;Jin Chen(The Second Affiliated Hospital of Chengdu Medical College(Nuclear Industry 416 Hospital),Chengdu,Sichuan 610041,China)
出处
《中国现代医学杂志》
CAS
北大核心
2021年第17期29-35,共7页
China Journal of Modern Medicine
关键词
膝骨关节炎
帕瑞昔布钠
超前镇痛
人工膝关节置换术
炎症因子
认知功能
osteoarthritis,knee
parecoxib
preemptive analgesia
artificial knee joint replacement
inflammatory factors
cognitive function
