塞来昔布在关节镜下膝关节手术后镇痛中的应用

Use of Celecoxib in Postoperative Analgesia after Arthroscopically-assisted Knee Operation

【目的】通过与传统非甾体类消炎镇痛药物扶他林、阿片类镇痛药物曲马多及安慰剂的比较,评价特异性环氧化酶-2抑制剂塞来昔布在膝关节镜术后镇痛应用中的临床疗效及安全性。【方法】选取膝关节镜手术患者136例(男49例,女87例)随机分为4组,其中塞来昔布组41例、曲马多组34例、扶他林组31例,对照组30例,分别给予塞来昔布、曲马多、扶他林及安慰剂,检测术后视觉模拟评分法疼痛评分、膝关节活动度、关节肿胀、积液程度及药物不良反应。【结果】塞来昔布组、曲马多组和扶他林组术后早期疼痛评分均较对照组明显降低,关节活动度增大,四组间关节积液程度无明显差异。药物不良反应发生率分别为曲马多组20.6%、塞来昔布组2.4%、扶他林组6.5%、对照组3.3%,曲马多组药物不良反应发生率较其他组明显增高(P<0.05)。【结论】膝关节镜术后应用塞来昔布可明显缓解患者疼痛,其不良反应低于阿片类药物曲马多和传统的NSAIDs类药物扶他林,具有良好的临床疗效和安全性。

[Objective] To compare the analgesic efficacy and safety of cyclooxygenase-2 （COX-2） inhibitor celecoxib with traditional non-steroidal anti-inflammatory drugs （NSAIDs） votalin, the opioid tramadol and placebo in post-operative pain after arthroscopically-assisted knee operation. [Methods] A total of 136 patients （49 males and 87 females） who prepared to receive arthroscopically-assisted knee operation were selected. Then the randomized, double-blind, placebo controlled study was conducted. The patients were assigned to 4 groups： 41 patients in celecoxib group, 31 patients in votalin group, 34 patients in tramadol group, and 30 patients in placebo group. The primary observational indexes were Visual Analogue Score （VAS） pain scores, postoperative hemarthrosis volume, postoperative range of motion （ROM） of the troubled knee joints and the incidence of side effects. [Results] VAS pain scores in celecoxib group, votalin group, and tramadol group were significantly reduced compared with placebo group, while postoperative ROM were improved. There was no significant difference in the postoperative hemarthrosis volume. The incidences of side effects were 20.6% in tramadol group, 2.4% in celecoxib group, 6.5% in votalin group and 3.3% in placebo group, respectively, in which the incidences in tramadol group were significantly increased （P 〈 0.05）. [Conclusion] The post-operative use of celecoxib can effectively reduce the postoperative pain after arthroscopically-assisted knee operation, meanwhile, it will not increase the risk of side effects compared with votalin and tramadol. It is an excellent anodyne for postoperative analgesia.