摘要
目的:观察是否在切开前使用帕瑞昔布可以降低全髋关节置换术后疼痛和调节炎症反应。方法:病人被随机分为皮肤切开前使用帕瑞昔布组(切开前组)和皮肤切开后使用帕瑞昔布组(切开后组),分别静脉注射40mg帕瑞昔布,吗啡用于常规术后镇痛。分别于术后1、6、18、24h,应用疼痛视觉量表评分法(Visual analog pain scale,VAS)的分数和术后所记录的吗啡消耗量进行评估。分别于皮肤切开前30min和术后6h测定血浆白介素6(IL-6)、白介素8(IL-8)和肿瘤坏死因子α(TNF-α)水平。结果:切开前组的术后1h和术后6h的疼痛视觉量表评分分数明显低于切开后组。切开前组术后6h、8h和24h的吗啡消耗量也显著低于对照组。两组中,术后6h所测得的IL-6和IL-8的水平均较术前显著增加,而且,切开前组的术后6h的IL-6和IL-8的水平显著低于切开后组。结论:皮肤切开前使用帕瑞昔布能降低术后疼痛和减少吗啡的消耗量,而且能够减少全髋置换术后24h内IL-6和IL-8等炎性介质的产生。
Objective:To observe whether preincisional pain management by use of parecoxib can reduce postoperative pain and modulate perioperative inflammatory response after total hip replacement surgery.Methods:Sixty-five patients who were scheduled for total hip replacement surgery were randomly divided in two groups:the study group received parecoxib 40mg intravenously 30min before skin incision and the control group received the same dose 30 min after skin incision.Postoperative analgesia involved the administration of patient-controlled analgesia(PCA)morphine to all patients.Visual analog pain scale(VAS)scores and morphine consumption were recorded and evaluated at 1,6,18,and 24hours after surgery and blood levels of IL-6,IL-8,and TNFwere determined both 30min before skin incision(Tpre)and 6hours postoperatively(T6h)in both groups.Results:VAS pain scores at both 1and 6hours after surgery were signi?cantly lower in the study group(P<0.05).Morphine consumption was signi,cantly lower in the study group at 6h(P=0.006),18h(P<0.001),and 24h(P<0.001)postoperatively.In both groups,the concentrations of IL-6and IL-8increased signi,cantly at T6hcompared to Tpre,and the study group had significantly lower levels of IL-6and IL-8at T6hcompared with the control group.The levels of TNF-exhibited no signi,cant difference between groups at T6h,or between measurement points(Tpre and T6h)within groups.Conclusion:Preincisional parecoxib administration,compared to postincisional administration,can reduce postoperative pain and morphine consumption,and attenuate IL-6and IL-8production in 24hours after total hip replacement surgery.
