塞来昔布对四肢骨折急诊手术患者的镇痛作用分析

Perioperative celecoxib administration in pain management of limbs fracture surgery

目的观察四肢骨折急诊手术患者围手术期使用塞来昔布的镇痛效果。方法 290例患者分为三组,A组100例,在手术前口服塞来昔布400mg,术后当天口服200mg,手术后第1-5天,口服200mg/次,每日2次;B组90例,术后当天口服200mg,手术后第1-5天,口服200mg/次,每日2次;B组100例,不服用塞来昔布,两组在手术后均不限制使用静脉止痛泵、肌注阿片类药物。观察两组术后疼痛的VAS评分、阿片类药物的用量以及呕吐情况。结果 A组在术后当天、术后第1天、第2天手术切口疼痛的VAS评分低于B、C组,差异有显著性（P〈0.05）;术后第3天-第5天,手术切口疼痛的VAS评分相比无显著性差异。在术后当天至术后第5天内,A组使用哌替啶的次数少于B、C组（P〈0.05）;出现呕吐的次数也低于对照组（P〈0.05）。结论在四肢骨折急诊手术患者的围手术期使用塞来昔布对患者有良好的镇痛效果,可减少术后阿片类药物的使用,减少术后呕吐反应,且超前镇痛仍有适用的意义。

Objective To evaluate the effects of perioperative celecoxib administration in pain management of patients undergoing limbs fracture surgery.Methods 290 cases with limbs fracture surgery were divided into three groups,100 cases in A group, oral administration with celecoxib 400mg 8h before surgery,200mg in the same day after surgery and 200mg twice a day during five days after surgery.and 90 cases in B group.Cases,oral administration with celecoxib 200mg in the same day after surgery and 200mg twice a day during five days after surgery.Cases in C group,administration without celecoxib.All the three groups did not restrict the requirements of intravenous analgesic pump,injected opioids after surgery.After surgery,pain intensity was measured with visual analog scale（VAS）,and opium analgesic requirements, and the circumstances of vomit were observed.Results In the same day、the first day and second day after surgery,the VAS pain scores of A group were lower than those of other groups significantly（P〈0.05）.However,in the third day,the fourth day,and the fifth day after surgery,there were no significant differences between the three groups in the VAS pain scores（〉P0.05）.From the same day to the fifth day after surgery,the frequency of pethidine administration and vomit in the A group was lower than that in the other groups（P〈0.05）.Conclusion Perioperative celecoxib oral administration can enhance the analgesic effect,reduce the opioids requirements and vomit.Preoperative celecoxib administration is valuable.