环氧化酶-2抑制剂控制全膝关节置换术后疼痛的临床研究  

Analgesia of COX-2 inhibitor after total knee arthroplasty

作　　者：庞显伦[1] 黄伟[1] 梁熙[1] 胡宁[1] 

机构地区：[1]重庆医科大学附属第一医院骨科,400016

出　　处：《中华创伤杂志》2011年第3期224-227,共4页Chinese Journal of Trauma

摘　　要：目的观察环氧化酶-2（COX-2）抑制剂联合自控镇痛（PCA）控制全膝关节置换术（TKA）后疼痛的效果，探索TKA术后疼痛控制的新方法。方法选取研究纳入标准：膝关节病变需要行TKA手术的患者，年龄58～75岁，美国麻醉师协会（ASA）分级为I或Ⅱ级，能耐受全身静脉复合麻醉。术后常规根据患者体重采用相同配方配制自控镇痛溶液，关闭切口结束同时随机静脉注射2ml等渗盐水或帕瑞昔布钠40mg＋等渗盐水2ml，由研究者甲记录并开具医嘱，间隔12h连续用相同试剂静脉注射，48h后结束。第72小时起口服赛来昔布或安慰胶囊连续服用至2周。观察术前、术后3，7，15d膝关节功能。结果共完成60例，其中用帕瑞昔布钠、赛来昔布序贯疗法组30例，安慰剂组30例。两组患者一般情况差异无统计学意义（P〉0．05），术前膝关节功能评分差异无统计学意义（P〉0．05）。术后第3，7，15天膝关节功能评分差异有统计学意义（P〈0．05，0．01）。结论COX-2抑制剂联合自控镇痛TKA术后疼痛疗效确切，且与TKA术后早期改良HSS评价成正相关。Objective To observe the analgesic effect of COX-2 inhibitors combined with PCA in treatment of the pain after total knee arthroplasty （TKA） and explore noval method for pain control after TKA. Methods This study was a double blind, controlled, randomized, placebo-controlled, parallelgroup and single center study and obtained the consent of the Medical Ethics Committee of Chongqing Medical University. Inclusion criteria： the patients with severe trauma or degenerative knee, at age of 58- 75 years, ASA I or II , tolerance of the intravenous anesthesia. The same solvent formula of PCA was routinely prepared based on body weight after TKA. Intravenous injection of 40 mg Parecoxib plus 2 ml normal saline or injection of only 2 ml normal saline was done when closing the incision, which was recorded and prescribed by the researcher A. The same reagent was used continually every other 12 hours till 48 hours. Celecoxib or placebo capsules was not used orally at 72 hours until two weeks later. The knee joint function was observed preoperatively and at days 3, 7 and 15 after TKA. Results The study was completed in 60 patients including 30 patients in the group treated with Parecoxib and Celecoxib sequen- tial therapy and 30 patients in placebo-control group. There was no statistical difference in aspects of general condition in both groups （ P 〉 0.05 ）. There was no statistical difference in aspect of preoperative knee score between two groups （ P 〉 0.05 ）. The analysis showed statistical difference in the knee func- tion score at days 3, 7 and 15 after operation （ P 〈 0.05 or 0.0K ）. Conclusions The COX2. inhibitors combined with PCA has definite analgesic effect on the pain after TKA, which positively correlates with early modified HSS evaluation of TKA.

关 键 词：疼痛 术后 关节成形术 置换 膝 环氧化酶2抑制剂 镇痛 病人控制 

分 类 号：R687.4[医药卫生—骨科学]