帕瑞昔布超前镇痛对膝关节骨性关节炎全膝关节置换术患者的镇痛效果及对炎性因子的影响  

Analgesic Effect of Preemptive Analgesia with Parecoxib and Its Influence on Inflammatory Response in Patients with Knee Osteoarthritis Undergoing Total Knee Arthroplasty

作　　者：张亚美[1] 王敬[1] 罗珊 吴艳萍 孙卧林[1] 董雨[1] 王娟[1] ZHANG Ya-mei;WANG Jing;LUO Shan;WU Yan-ping;SUN Wo-lin;DONG Yu;WANG Juan(Department of Anesthesiology,Cangzhou Hospital of Integrated TCM-WM,Cangzhou,Hebei 061001,China)

机构地区：[1]河北省沧州中西医结合医院麻醉科,河北沧州061001

出　　处：《临床误诊误治》2020年第3期89-93,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫生健康委员会科研项目(20191288)。

摘　　要：目的探讨帕瑞昔布超前镇痛对膝关节骨性关节炎行全膝关节置换术患者的镇痛效果及对炎性因子的影响。方法选取2016年10月—2018年10月收治的行全膝关节置换术的膝关节骨性关节炎78例,根据是否采用超前镇痛方法,分为观察组(n=38)和对照组(n=40)。观察组于麻醉诱导前30 min静脉注射帕瑞昔布,对照组术前不采取任何超前镇痛措施。采用视觉模拟评分(visual analog scale,VAS)评估术后6、12、24 h的疼痛程度,记录术后24 h自控镇痛泵(patient controlled analgesia,PCA)按压次数与曲马多使用量,检测术前和术后6、12、24 h血清炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF)-α]水平,观察术后24 h不良反应发生情况。结果与对照组比较,观察组术后6、12、24 h的VAS及IL-6、TNF-α水平降低,术后24 h的PCA按压次数及曲马多使用量均减少,差异有统计学意义(P<0.05)。观察组、对照组不良反应总发生率分别为7.89%(3/38)、27.50%(11/40),比较差异有统计学意义(χ2=3.964,P=0.016)。结论帕瑞昔布超前镇痛对行全膝关节置换术的膝关节骨性关节炎患者的镇痛效果良好,可减少术后镇痛药物使用量及不良反应发生情况,减轻机体炎性反应。Objective To investigate the analgesic effect of preemptive analgesia with parecoxib on patients with knee osteoarthritis(KOA)undergoing total knee arthroplasty(TKA)and its influence on inflammatory factors.Methods From October 2016 to October 2018,78 cases of KOA treated by TKA in our hospital were divided into observation group(n=38)and control group(n=40)according to application of preemptive analgesia.The observation group was injected with parecoxib 30 min before anesthesia induction,and the control group did not receive any preemptive analgesia before operation.Visual analog scale(VAS)was used to evaluate the degree of pain at 6h,12h and 24h postoperatively.The times of pressing patient-controlled analgesia(PCA)and the dosage of tramadol were recorded at 24h postoperatively.Serum inflammatory factor related indicators[interleukin-6(IL-6)and tumor necrosis factor(TNF)-α]were measured before operation and at 6h,12h and 24h after operation,and adverse reactions were observed at 24 h after operation.Results The VAS score,and the levels of IL-6 and TNF-αin observation group were significantly lower than thosein the control group at 6,12 and 24 h after operation(P<0.05).PCA pressing times and tramadol dosage in observation group at 24 h after operation were significantly less than those in the control group(P<0.05).The total incidence of adverse reactions in observation group and control group was 7.89%(3/38)and 27.50%(11/40)respectively,and there were significant differences(χ2=3.964,P=0.016).Conclusion Parecoxib has a good analgesic effect on patients with KOA undergoing TKA,which can reduce the dosage of analgesic drugs,adverse reactions,and the inflammatory responses of the body.

关 键 词：骨关节炎 膝 帕瑞昔布 关节成形术 置换 膝 超前镇痛 白细胞介素6 肿瘤坏死因子Α 

分 类 号：R684.3[医药卫生—骨科学]