塞来昔布对膝关节镜手术患者术前疼痛影响的前瞻性随机对照研究

Effect of Celebrex on preoperative pain in patients undergoing knee arthroscopy： a prospective randomized, double-blind, placebo-controlled trial

目的 探讨塞来昔布对膝关节镜手术患者术前疼痛的影响及术前预防性镇痛的有效性. 方法 采用前瞻性随机对照研究方法,以2012年6月至2013年5月因外伤行膝关节镜手术的30例患者为研究对象,男8例,女22例;年龄为15 ～59岁.将30例患者按随机数字表法随机分为塞来昔布组和维生素C组,每组15例.入院后第2～4天塞来昔布组患者口服塞来昔布,维生素C组患者口服维生素C,分别于入院当晚（用药前1d）及用药后第3天采用视觉模拟评分（VAS）评定患者患侧静息及运动时的疼痛程度,应用痛阈测量仪测量患者的痛阈及耐痛阈值,比较两组患者的疗效.结果 塞来昔布组患者用药前与用药后的静息VAS评分[（1.22 ±0.90）分 vs.（1.00±0.81）分]、运动VAS评分[（4.23±1.38）分 vs.（3.68±1.02）分],健侧痛阈[（1.57±0.56） mA vs.（1.79±0.51）mA]、患侧痛阈[（1.33±0.48） mAvs.（1.79 ±0.57） mA]比较差异均有统计学意义（P＜0.05）,而用药前与用药后的健侧、患侧耐痛阈比较差异均无统计学意义（P＞0.05）.维生素C组以上项目比较差异均无统计学意义（P＞0.05）.塞来昔布组患者运动VAS评分的变化差值与健、患侧痛阈的变化差值呈显著负相关（r健侧=-0.564,P健侧=0.028;r患侧=-0.746,P患侧=0.001）. 结论 塞来昔布能够降低膝关节镜手术患者术前的疼痛程度,提高痛阈,可发挥预防性镇痛作用,用药前、后患者的疼痛程度与痛阈的变化存在一定相关性.

Objective To investigate the effect of Celebrex on the preoperative pain in patients undergoing knee arthroscopy.Methods From June 2012 to May 2013,30 patients who would receive knee arthroscopy for simple acute or sub-acute knee injury were enrolled in the study after they had been accessed by Pittsburgh Sleep Quality Index （PSQI）,Self-rating Depression Scale （SDS） and Self-rating Anxiety Scale（SAS）.They were 8 males and 22 females,aged from 15 to 59 years.They were evenly randomized into a Celebrex group and a vitamin C group （n =15）.The patients in Celebrex group took 200mg Celebrex twice a day from day 2 to day 4 after admission.Likewise,those in vitamin C group took vitamin C instead.Visual Analogue Scale （VAS） was used to evaluate their resting and moving pain in the evenings of day 1 and day 4.At the same time,pain threshold and pain tolerance of both lower limbs were recorded by a pain-threshold machine.The 2 groups were statistically compared.Results In Celebrex group,there were statistically significant differences between pre-medication and post-medication in resting VAS （1.22 ± 0.90 versus 1.00 ± 0.81）,moving VAS （4.23 ± 1.38 versus 3.68 ± 1.02）,pain threshold of the normal lower limb （NL） （1.57 ± 0.56 mA versus 1.79 ± 0.51 mA）,pain threshold of affected lower limb （AL） （1.33 ± 0.48 mA versus 1.79 ± 0.57 mA） （all P 〈 0.05）,but there were no statistically significant differences between pre-medication and post-medication in pain tolerance of either of NL and AL （all P 〉 0.05）.In vitamin C group,the above comparisons were statistically insignificant （all P 〉 0.05）.In Celebrex group,the variation values of moving VAS were significantly negatively correlated with those of pain threshold of the NL and AL （rNL =-0.564,PNL =0.028;rAL =-0.746,PAL =0.001）.Conclusions Celebrex can reduce preoperative pain and increase pain threshold in patients undergoing knee arthroscopy,playing a role in preventive analgesia.There may be correlations between variations of pain and pain threshold before and after medication.