塞来昔布预给药+腰丛神经阻滞复合全身麻醉对髋关节置换术患者术后疼痛、炎症因子及关节功能恢复的影响  

Effects of Celecoxib Preadministration Plus Lumbar Plexus Block Combined with General Anesthesia and Lumbar Plexus Block on Postoperative Pain,Inflammatory Factors and Joint Function Recovery in Patients with Hip Replacement

作　　者：刘贤庭 Liu Xianting(Department of Anesthesiology and Surgery,Sanmenxia Traditional Chinese Medicine Hospital,472000,China)

机构地区：[1]三门峡市中医院麻醉手术科,河南三门峡472000

出　　处：《哈尔滨医药》2025年第2期40-43,共4页Harbin Medical Journal

基　　金：河南省医学科技攻关计划(LHOJ20221045)。

摘　　要：目的探讨塞来昔布预给药+腰丛神经阻滞复合全身麻醉对髋关节置换术患者术后疼痛、炎症因子及关节功能恢复的影响。方法选取接受髋关节置换术的患者86例,随机数字表法分为观察组(n=43)和对照组(n=43)。两组患者均接受腰丛神经阻滞复合全麻,术后采用静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA),观察组在此基础上在麻醉诱导前8 h口服塞来昔布。比较术后不同时间点静息和活动状态下的疼痛程度、血清中炎症及疼痛因子水平。记录首次直腿抬高时间、屈髋90°时间以及术后患侧髋关节最大屈曲度和最大外展活动度。记录术后恢复情况和围术期不良事件。结果观察组术后6、12、24、48 h时静息和活动状态下视觉模拟评分法(Visual analog scale,VAS)评分均显著低于对照组(P<0.05)。观察组术后24、48 h时血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、前列腺素E2(Prostaglandin E2,PGE2)、β-内啡肽(β-endorphin,β-EP)水平均显著低于对照组(P<0.05)。观察组首次直腿抬高时间和屈髋90°时间显著短于对照组,术后24、48 h患侧髋关节最大屈曲度和最大外展活动度显著大于对照组(P<0.05)。观察组苏醒时间、拔管时间、下床活动时间显著短于对照组,术后48h内PCIA按压次数显著少于对照组(P<0.05)。观察组术后谵妄发生率及围术期不良事件总发生率显著低于对照组(P<0.05)。结论塞来昔布联合腰丛神经阻滞能够有效提高髋关节置换术后镇痛效果,降低术后炎症和疼痛因子水平,促进髋关节功能恢复,减少术后谵妄发生,值得推广。Objective To investigate the effects of pre-administration of celecoxib combined with lumbar plexus block and general anesthesia on postoperative pain,inflammatory factors,and joint function recovery in patients undergoing hip replacement surgery.Methods A total of 86 patients admitted to the hospital for hip replacement surgery were randomly divided into an observation group(n=43)and a control group(n=43).Both groups received lumbar plexus block combined with general anesthesia,followed by patient-controlled intravenous analgesia(PCIA)postoperatively.Additionally,the observation group took oral celecoxib 8 hours before anesthesia induction.Pain levels at rest and during activity at different time points postoperatively,as well as serum levels of inflammatory and pain factors,were compared.The time to first straight leg raise,hip flexion to 90°,and the maximum flexion and abduction range of the affected hip joint postoperatively were recorded.Postoperative recovery and perioperative adverse events were also documented.Results The Visual Analog Scale(VAS)scores at rest and during activity at 6,12,24,and 48 hours postoperatively were significantly lower in the observation group than in the control group(P<0.05).Serum levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),prostaglandin E2(PGE2),andβ-endorphin(β-EP)at 24 and 48 hours postoperatively were significantly lower in the observation group than in the control group(P<0.05).The time to first straight leg raise and hip flexion to 90°was significantly shorter in the observation group,and the maximum flexion and abduction range of the affected hip joint at 24 and 48 hours postoperatively were significantly greater than those in the control group(P<0.05).The recovery time,extubation time,and time to ambulate were significantly shorter in the observation group,and the number of PCIA compressions within 48 hours postoperatively was significantly lower than that in the control group(P<0.05).The incidence of postoperative delirium and the total incidence

关 键 词：髋关节置换术 塞来昔布 腰丛神经阻滞 镇痛 炎症因子 关节功能 

分 类 号：R971.2[医药卫生—药品]