塞来昔布在痔疮手术中的超前镇痛作用

Effects of preemptive analgesia with celecoxib in hemorrhoids operation

目的评价塞来昔布在痔疮手术中的超前镇痛效果。方法40例择期行痔疮手术患者随机分为两组，每组20例。所有患者均采用连续硬膜外阻滞麻醉，试验组术前2h予塞来昔布400mg口服，对照组不服药物。采取疼痛视觉模拟量表评分（VAS）法评估患者术后1～3d镇痛效果，并记录镇痛药应用情况。采用酶联免疫吸附法检测手术前后患者血清环加氧酶2（COX-2）和前列腺素E2（PGE-2）水平。结果术后第1日试验组创面疼痛VAS低于对照组（P〈0．05），术后第2、3日两组VAS差异无显著意义（P〉0．05）。术后3d内试验组使用阿片类药物次数少于对照组（P〈0．05）。术前两组血清COX-2、PGE-2水平均无显著差异（P〉0．05）。术后试验组血清COX．2水平下降（P〈0．05），而对照组升高（P〈0．05）．组间差异显著（P〈0．05），两组血清PGE-2水平均无明显变化（P〉0．05）。结论塞来昔布超前镇痛能够减轻痔疮手术患者术后疼痛，降低患者COX-2水平。

AIM To evaluate effect of preemptive analgesia with celecoxib in hemorrhoids operation. METHODS Forty patients undergoing hemorrhoids operation were randomly allocated into trial group and control group （20 in each）. All patients received continuous epidural anesthesia. The patients in the trial group took celecoxib 400 mg 2 hours before the operation, while other patients in the control group took no preoperative medication. The indexes of visual analogue score （VAS） were recorded to evaluate effects of preemptive analgesia within three days after the operation, and adverse reactions after the operation were observed. The levels of serum cyclooxygenase 2 （COX- 2） and prostaglandin E2 （PGE- 2） were tested by enzyme linked immunosorbent assay （ELISA） before and after the operation. RESULTS The VAS in the trial group was significantly lower than that in the control group at 1 day after operation （P 〈 0.05）, and there was no significant difference at 2 and 3 days after operation （P 〉 0.05）. The frequency of use opioid drugs in the trial group was significantly lower than that in the control group （P 〈 0.05）. There was no significant difference of preoperative serum COX- 2 and PGE- 2 concentration before the operation between two groups （P 〉 0.05）. The postoperative serum COX-2 concentration of trial group was decreased （P 〈 0.05） and the control group was increased （P 〈 0.05） , with significantly difference （P 〈 0.05）. There was no significant difference in postoperative serum PGE-2 concentration between two groups （P 〉 0.05）. There was no significant difference in incidence rate of adverse drug reactions between two groups （P 〉 0.05）. CONCLUSION Preemptive analgesia with celecoxib can relief pain in patients undergoing hemorrhoids operation and decrease serum COX-2 level.