鲑鱼降钙素联合帕瑞昔布钠对老年骨质疏松性粗隆间骨折围手术期疼痛的影响

EFFECTS OF SALMON CALCITONIN IN COMBINATION WITH PARECOXIB SODIUM ON PERIOPERATIVE ANALGESIA OF OSTEOPOROTIC INTERTROCHANTERIC FRACTURE

目的:研究鲑鱼降钙素联合帕瑞昔布钠对老年骨质疏松性粗隆间骨折患者围手术期疼痛的影响。方法:选择行手术治疗的老年骨质疏松性粗隆间骨折患者90例,采用抽签法将患者随机分为鲑鱼降钙素组(A组,n=30),帕瑞昔布钠组(B组,n=30),鲑鱼降钙素+帕瑞昔布钠联合治疗组(C组,n=30)。A组患者采用皮下注射鲑鱼降钙素50 IU/次,1次/日,持续2周;B组患者采用术后静脉注射帕瑞昔布钠40 mg/次,1次/12 h,持续3 d;C组采用以上两组联合用药。观察术后静息状态视觉模拟评分(resting visual analogue scale,RVAS)、主动运动状态VAS(AVAS)及持续被动运动VAS(PVAS),患者能主动直腿抬高时间、主动屈髋90°时间以及药物不良反应。结果:术后12 h、1 d,2 d,3 d,4 d,C组的RVAS评分明显低于另两组;术后1 d,2 d,3 d,4 d,C组的AVAS、PVAS评分均低于另两组(P<0.01);术后5 d,C组的RVAS、AVAS、PVAS评分与另两组相当;C组术后主动直腿抬高时间、主动屈髋90°时间早于另两组(P<0.01),且未出现严重不良反应。结论:鲑鱼降钙素联合帕瑞昔布钠治疗老年骨质疏松性粗隆间骨折围手术期镇痛效果良好、安全性高。

Objective： To evaluate the effects of salmon calcitonin in combination with parecoxib sodium on perioperative analgesia of osteoporotic intertrochanteric fracture. Methods： Totally 90 patients with osteoporotic intertrochanteric fracture who underwent surgical treatment were randomly divided into salmon calcitonin group （group A, n = 30）, parecoxib sodium group （group B, n = 30）, and salmon calcitonin - parecoxib sodium combination therapy group （group C, n = 30）. Group A were treated with subcutaneous injection of salmon calcitonin 50 IU qd for 2 weeks. Group B were treated with postoperative intravenous parecoxib sodium 40 mg q12 h for 3 days. Group C were treated with both of them. Visual analogue scale （VAS） pain scores were recorded during rest state （RVAS）, active movement state （AVAS） and continuous passive motion state （PVAS）. The time point of active straight leg raising, hip active flexion to 90 degree, and adverse drug reactions were recorded as well. Results： RVAS scores in group C were significantly lower than those in the other two groups at 12 h, 1 d, 2 d, 3 d, 4 d, after operation. AVAS and PVAS scores in group C were lower than those in the other two groups at 24, 48, 72, 96 h after operation （P 〈 0.01）. At 5 d after operation, RVAS, AVAS and PVAS scores in group C were comparable with those in the other two groups. The time points of active straight leg raising and hip active flexion to 90 ° in group C were earlier than those in the other two groups （P 〈 0.01）, meanwhile no serious adverse reactions were recorded in group C. Conclusion： Salmon calcitonin in combination with parecoxib sodium can provide good pain relief and high safety in treatment ofperioperative analgesia ofosteoporotic intertrochanteric fracture.