环氧化酶-2抑制剂在膝关节置换围手术期镇痛及功能康复的作用

Application of COX-2 inhibitor in total knee arthroplasty analgesia during perioperative period

目的观察膝关节表面置换围手术期应用环氧化酶-2(COX-2)抑制剂序贯镇痛治疗及术后膝关节功能恢复的效果。方法将拟手术的60例膝关节表面置换手术患者随机分成观察和对照组:观察组术前24 h、12 h给予口服塞来昔布(200 mg),术毕使用镇痛泵2 d,术后3 h开始使用帕瑞昔布钠(40 mg,2次/d)静注,连续使用3 d后改为口服塞来昔布(200 mg、2次/d);对照组术前24 h、12 h给予口服曲马多片(10 mg),术毕使用镇痛泵2 d,术后3 h开始使用曲马多注射液(100 mg,2次/d)静注,连续使用三天后改为口服曲马多片(10 mg、2次/d)。分别记录静息、活动时(6、12、24、36、48、72 h)视觉模拟评分(VAS),记录术前、术后7 d及末次随访膝关节功能HSS评分。记录不良反应及术后需要止痛药援助情况。结果手术前两组疼痛程度的VAS评分无统计学差别(P>0.05);观察组术后静息、活动时(6、12、24、36、48、72 h)的视觉模拟评分有差别有统计学意义(P<0.05);手术前两组膝关节功能HSS评分无统计学差别(P>0.05),手术后7 d及末次随访时膝关节功能HSS评分观察组高于对照组(P<0.05);术后需要止痛药援助情况观察组低于对照组(P<0.05);消化道不良反应的发生率观察组低于对照组(P<0.05);夜间睡眠满意度调查观察组高于对照组(P<0.05)。结论 COX-2抑制剂序贯治疗在膝关节表面置换围手术镇痛中效果确切、膝关节功能恢复满意,副作用小、改善手术后膝关节活动范围、加快患肢功能锻炼及改善睡眠状况,适合人工膝关节表面置换的围手术期镇痛。

Objective To observe the knee joint function and the effects of COX -2 inhibitor therapy for analgesia during the perioperative period of the total knee arthroplasty （TKA）.Methods 60 patients were randomly divided into the observation group and the control group .The observation group were given Celebrex （ 200 mg ） 24 h and 12 h preoperatively while the control group were given Tramadol （ 10＆amp;nbsp;mg） .All the patients accepted analgesia pump postoperatively for two days .The observation group and the control group were given Parecoxib （40 mg, 2 times/day） and Tramadol （100 mg, 2 times/day） intravenous injection respectively , three hours postoperatively for three days .After that, the observation group took oral Celecoxib （200 mg, 2 tims/day）while the control group took oral Tramadol （10 mg, 2 times/days） for three consecutive days .The data were recorded including the visual analog scale （ VAS） scores at rest and during activity （6, 12, 24, 36, 48, 72 h postoperatively ）, and HSS scores before the surgery ,T days after the surgery and at the last follow -up for the knee function .Results The postoperative VAS scores at rest and during activity were significantly different （ P 〈0.05 ） between the two groups . HSS scores of the observation group were significant higher （ P 〈0.05 ） than that of the control group at the 7th day postoperatively .The night sleep satisfaction of the observation group was significantly higher than the control group （ P 〈0.05 ） .Conclusion The rehabilitation of the knee joint function could recover satisfactorily using COX-2 inhibitor therapy for analgesia during the perioperative period of the TKA .