肌肉注射帕瑞昔布钠用于全膝关节置换术病人术后镇痛的效果

Efficacy of intramuscular parecoxib for lmstoperative analgesia in patients undergoing total knee arthroplasty

目的评价肌肉注射帕瑞昔布钠用于全膝关节置换术病人术后镇痛的效果。方法拟行单侧全膝关节置换术的的骨关节炎病人54例，性别不限，年龄65—75岁，ASA分级I一Ⅲ级，采用随机数字表法，将病人随机分成2组（n=27）：曲马多组（T组）和帕瑞昔布钠组（P组）。2组均采用全凭静脉麻醉。P组分别于术前12h及术后12、24、36、48、60、72h时肌肉注射帕瑞昔布钠40mg，T组在相应时间点给予曲马多100mg。当术后镇痛无效（VAS评分〉3分）时肌肉注射哌替啶50mg进行补救镇痛，分别记录静态和动态时镇痛无效情况。记录术后膝关节活动度达到90°的时间和心血管事件发生情况；术后7、14d行双下肢静脉多普勒超声检查，记录下肢静脉血栓形成的发生情况。结果与T组比较，P组静态和动态时镇痛无效率降低，术后膝关节活动度达到90°时间缩短，深静脉血栓形成发生率降低（P〈0．05或0．01），心血管事件发生率和肌间静脉血栓形成发生率差异无统计学意义（P〉0．05）。结论术前12h及术后间断肌肉注射帕瑞昔布钠40mg可明显缓解全膝关节置换术病人术后疼痛，有助于术后关节功能的康复，且可降低深静脉血栓形成的发生。

Objective To evaluate the efficacy of intramuscular parecoxib for postoperative analgesia in patients undergoing total knee arthroplasty. Methods Fifty-four ASA I -Ill patients, aged 65-75 .yr, scheduled for unilateral total knee arthroplasty, were randomly divided into 2 groups （ n = 27 each） ： tramadol group （group T） and pareeoxib group （group P）. Total intravenous anesthesia was used in both groups. Group P received intramuscular injection of parecoxib 40 mg at 12 h before operation and 12, 24, 36, 48, 60 and 72 h after operation, and group T received tramadol 100 mg at the same time points. When AS score was more than 3 after operation, intramuscular parecoxib 50° mg was given as rescue analgesic. The ineffective analgesia at rest and during activity was recorded. The time for knee range of motion to reach 90° and cardiovascular events were recorded. The ultra- sonic inspection was performed on veins of the bilateral lower extremities at 7 and 14 days after operation for detection of vein thrombosis. Results Compared with T group, the rate of ineffective analgesia at rest and during activity was significantly decreased, the time for knee range of motion to reach 90° was shortened, and the incidence of deep vein thrombosis was significantly decreased （ P 〈 0.05 or 0.01 ）, and no significant change was found in the incidences of cardiovascular events and intramuscular venous thrombosis in group P （P 〉 0.05 ）. Conclusion Parecoxib 40 mg injected intramuscularly before and after operation can significantly relieve postoperative pain, is helpful for the hip function rehabilitation and can reduce the occurrence of deep vein thrombosis in patients underg- oing total knee arthroplasty.