氯诺昔康治疗股骨骨折后疼痛对患者皮质醇及凝血功能的影响

THE INFLUENCE OF PREOPERATIVE APPLICATION OF LORNOXICAM ON CORTISOL AND COAGULATION IN FEMORAL FRACTURE

为研究氯诺昔康治疗股骨骨折后疼痛对皮质醇及凝血功能的影响,评价氯诺昔康用于股骨骨折术前消炎止痛的有效性和可行性。将40例创伤闭合股骨骨折当天入院的病人随机分为两组,对照组(Ⅰ组),病人入院至第6天,不给予任何与凝血功能有关的药物,患者伤肢剧烈疼痛无法忍受时临时给予颅痛定60mg,肌肉注射。实验组(Ⅱ组),病人入院第2～6天(术前1天)连续给予氯诺昔康每次8mg,每天2次肌肉注射。两组病人均于入院第2、7天(手术日清晨),空腹采上肢静脉血标本,测定血清皮质醇浓度和凝血功能相关指标:DD二聚体、血小板计数、血小板聚集率、凝血弹性描记图的R时间、K时间、α角、血栓最大幅度。结果显示:①两组病人入院第2天,血清皮质醇均高于正常值(199±52ng·ml1)。Ⅰ组第7天比第2天增高,但P>0.01;Ⅱ组第7天比第2天下降,P<0.05。②两组病人入院第2天,DDi即增加超过正常值(<324μg·L1),其余各项指标在正常范围。Ⅰ组第7天与第2天比较,DDi增加,但P>0.01;PLC、PAgR、MA增大,P<0.01;α角增大,但P>0.01。Ⅱ组第7天与第2天比较,DDi减少,P<0.05;PLC增大,P<0.01;MA增大,P<0.05;PagR、α角增加,但P>0.01,两组病人R、K时间变化不大。表明氯诺昔康可用于创伤股骨骨折后的止痛治疗,其消炎止痛作用可降低病人的应激反应,而不影响病人的正常凝血功能,对创伤后的血液高凝状态有轻微的干预作用。

The objective of the paper is to study the influence of preoperative application of Lornoxicam on cortisol and coagulation in femoral fracture so as to evaluate the efficacy and operability of Lornoxicam used for pre-operative anti-inflammation and pains control in femoral fracture. Forty cases of closed femoral fracture were randomly divided into two groups: Group I and Group II (n= 20 cases each). Group I as the control were given no drugs related to the coagulation preoperatively except Rotundin taken (60mg, im) when the pains became severe and intolerable, and Group II as the experimental were given Lornoxicam (8mg, twice daily, im) from the 2nd to 6th day after admission; the fasting venous blood was sampled from the upper limbs of both groups on the 2nd and 7th (the early morning of the operation day) day, and the serum cortisol concentration and the indices related to coagulation, such as D-Di, PLC, PagR and TEC including R time, K time, α angle and MA, were detected. The results showed: ① The serum cortisol of both groups on the 2nd day after admission were higher than the normal (199±52ng.ml-1); compared with the 2nd-day, the 7th-day cortisol of Group I was increased but had P > 0.01, while the 7th-day cortisol of Group II was decreased (P < 0.05). ② The D-Di values of both groups on the 2nd day were increased and exceeded the normal (< 324μg·L-1) but all other indices remained in the normal range. In Group I compared with the 2nd-day, the 7th-day D-Di was increased but had P > 0.01 and so were the PLC, PagR and MA (P < 0.01) and α angle but having P > 0.01; and in Group II compared with the 2nd-day, the 7th-day D-Di was decreased (P < 0.05), the PLC was increased (P < 0.01), so was MA (P < 0.05) and so were PagR and α angle but having P > 0.01; the R time and K time of both groups had no great change, suggesting that Lornoxicam can be used to stop the pains after traumatic femoral fracture; the function to remove the inflammation and to control the pains could reduce the irritated response of the patient, mildly interfere with the high coagulation status after injury but not disturb the normal coagulation function.