超前镇痛对下肢骨折患者术后疼痛及应激反应的影响  

Effect of preemptive analgesia on the postoperative pain and stress responses of patients with leg fracture

作　　者：苏黎[1] 申群喜[2] 雷钊慧 李旭春[3] 李敏[1] 杨金星[1] 

机构地区：[1]深圳市第二人民医院骨三科,518035 [2]深圳市第二人民医院核医学科,518035 [3]深圳市第二人民医院骨二科,518035 [4]深圳市中航社区健康中心,518031

出　　处：《中华现代护理杂志》2012年第20期2404-2407,共4页Chinese Journal of Modern Nursing

摘　　要：目的探讨塞来昔布及帕瑞昔布联合应用进行超前镇痛对下肢骨折患者术后疼痛及应激反应的影响，以提供骨折术后的疼痛护理方法。方法将82例下肢骨折患者随机分为实验组和对照组各41例，实验组接受超前镇痛治疗，对照组接受常规镇痛治疗，比较两组患者术后4，8，12，24，48h视觉模拟评分（VAS），两组患者术前、术后0，4，12，24h血管紧张素Ⅱ、胰高血糖素和血皮质醇水平及两组不良反应发生率。结果实验组术后4，8，12hVAS评分分别为（3．54±0．68），（4．08±0．97），（3．41±0．59）分，分别低于对照组的（4．63±0．92），（5．38±1．17），（4．48±0．76）分，差异均有统计学意义（t分别为4．2745，4．8754，4．4537；P〈0．05），而术后24，48h两组VAS评分比较，差异无统计学意义（P〉0．05）；术后0，4，12h血管紧张素Ⅱ、胰高血糖素和血皮质醇水平实验组均低于对照组，差异均有统计学意义（P〈0．05），而术前及术后24h两组比较，差异均无统计学意义（P〉0．05）；对照组不良反应发生率为31．7％，高于实验组的7．3％，差异有统计学意义（x2=7．77，P〈0．01）；实验组患者共13例加用曲马多，对照组共32例加用曲马多，实验组术后曲马多的使用次数明显少于对照组，差异有统计学意义（x2=10．05，P〈0．01）。结论塞来昔布联合帕瑞昔布实施超前镇痛能够减轻下肢骨折患者术后疼痛，减轻患者术后应激反应，减少不良反应发生。Objective To study the effect of preemptive analgesia with celecoxib and parecoxib on the postoperative pain and stress responses of patients with leg fracture. Methods Eighty-two patients with leg fracture were randomly divided into experiment group （n = 41 ） which received preemptive analgesia, and control group（ n =41 ） which received routine analgesia. The visual analogue scale （VAS） was used to measured patients＇ pain at 4,8,12,24,48 h after operation. Levels of blood angiotensin-U,cortisol and glueagon were assayed at various times as follows： pre-operation,end of surgery,postoperative 0,4,12,24 h, and adverse effects rate was observed in two groups. Results The postoperative 4, 8, 12, 24 h score of experiment group were （ 3.54 ±0. 68 ）, （ 4. 08 ±0.97）, （3.41 ± 0.59）, respectively,lower than that of control group that were （4.63 ± 0.92）, （5.38 ± 1.17）, （4.48 ± 0.76 ）, and the differences were statistically significant （ t = 4. 274 5,4. 875 4,4. 453 7, respectively ; P 〈 0.05 ）. While there was no significant difference detected in the VAS score of 24,48h between two groups （P 〉 0.05 ）. Levels of blood angiotensin- I] , cortisol and glucagon of patients＇ in 0,4,12 h of experiment group were significantly lower than that of the control group （ P 〈 0.05 ）, while no significant difference was found in the pre- operation and post-operation 24 h between two groups（ P 〉 0.05 ）. Adverse effects rate of experiment group was 7.3% significantly lower than 31.7% that of control group, the difference was statistically significant （X2 = 7.77 ,P 〈0.01 ）. There were 13 cases received the medicine of tramadol in experiment group and 32 cases in control group, and the difference was statistically significant （ X2 = 10.05, P 〈 0. 01 ）. Conclusions Preemptive analgesia with celecoxib and parecoxib could decrease the postoperative pain of patients with leg fracture and reduce the adverse effects rate significantly and the stress reaction in post

关 键 词：疼痛 应激 超前镇痛 塞来昔布 帕瑞昔布 

分 类 号：R614[医药卫生—麻醉学]