塞来昔布预先镇痛与帕瑞昔布钠术后镇痛在脊柱手术围术期的应用

Application of preemptive celecoxib analgesia and postoperative parecoxib analgesia in the perioperative orthopaedics

目的 观察塞来昔布预先镇痛及帕瑞昔布钠术后镇痛在脊柱手术围手术期的疗效及探讨其作用机理.方法 择期脊柱手术88例随机均分为实验组、对照组.实验组在术前给予塞来昔布口服、术后即刻肌注帕瑞昔布钠;对照组在术后使用自控式静脉镇痛泵镇痛.术前与术后测定血清中COX-2和PGE2水平,记录VAS评分、术中出血量、术后切口引流量.结果 实验组VAS评分、术后血清PGE2和COX-2水平均低于对照组;术中出血量、切口引流量及药物不良反应发生率的两组差异无统计学意义.结论 脊柱手术在术前口服塞来昔布,术后肌注帕瑞昔布钠,镇痛效果优于静脉自控;围手术期应用上述药物能显著抑制PGE2与COX-2的释放.

Objective To investigate the clinical efficacy and machamsm ot preempuve ccic and postoperative parecoxib sodium in orthopaedic perioperation analgesia. Method Eighty-eight patients scheduled for spinal surgery were randomly divided into experimental and control groups. Celecoxib was used at preoperation and parecoxib sodium instantly after operation in the experimental group. The patient-controlled intravenous analgesia （PCIA） was used in control group after the operation. The level of COX-2 （cyclooxygenase-2） and PGE2 （prostaglandin E2） were measured before and after the operation. The VAS, blood loss during the operation and the volume of drainage after operation were recorded. Result The level of PGE2 and COX-2 and the VAS after operation in experimental group were lower than that in control group. The blood loss during operation, the vol- ume of drainage after operation and the incidence of adverse reactions between experimental and con- trol group were not significant differences. Conclusion With celecoxib at preoperation and parecoxib sodium instantly after operation, the effect of analgesia was better than that with patient controlled intravenous analgesia in orthopaedic surgery, the release of COX-2 and PGE2 can be restrained sig nificantly.