西乐葆超前镇痛在腰椎手术中的应用

Clinical application of celebrex preemptive analgesia in the lumbar surgery

目的探讨西乐葆超前镇痛在腰椎手术后的镇痛效果。方法将65例拟行腰椎髓核摘除术患者随机分为观察组和对照组。观察组33例在手术前24h口服西乐葆400mg，术前8h口服西乐葆200mg，对照组32例术前不给药；两组患者均于手术后第1～5天口服西乐葆200mg／次，2次，d；且不限制使用静脉止痛泵及阿片类药物。观察两组术后疼痛的VAS评分，记录患者睡眠情况，术后需辅助镇痛泵及阿片类药物镇痛情况以及不良反应等。结果两组入院时VAS评分差异无显著性（P〉0．05），麻醉前观察组VAS评分显著低于对照组（P〈0．05），观察组术后前3d手术切口疼痛的VAS评分低于对照组，差异有显著性（P〈0．05）；术后第4—5天两组的手术切口疼痛的VAS评分差异无显著性，观察组术后辅助镇痛泵及阿片类药物镇痛例数少于对照组（P〈0．05）；睡眠满意度显著高于对照组（P〈0．05），术后不良反应发生率（胃肠道反应、嗜睡等）发生率显著低于对照组（P〈0．05）。结论围手术期使用西乐葆超前镇痛，可有效缓解腰椎髓核摘除术后疼痛，疗效好且副作用小。

Objective To evaluate the effect of celebrex preemptive analgesia in patients after lumbar surgery. Methods 65 patients undergoing lumbar discectomy were randomly divided into the observation group and the control group. 33 patients in observation group received celecoxib orally 400 mg 24 h before surgery and 200 mg 8 h before surgery, and 32 patients in control group were not administered celebrex. Both two groups took celebrex 200 mg orally twice a day from 1-5 d after the surgery and did not restrict the requirements of intravenous analgesic pump, injected or oral opioids after surgery. The postoperative pain VAS scores, the patients＂ sleep, postoperative adjuvant analgesia and opioid analgesia and adverse reaction etc. were observed in two groups. Results The VAS score had no significant difference between two groups when they admitted; yet the VAS score of the observation group was significantly lower than the control group before surgery and in the first three days after surgery, and the VAS score had no significant difference in the following two days. The need for supplementary analgesia and opioid analgesia in observation group were significantly less than those of the control group （P〈0.05）. The incidence of postoperative adverse reactions （gastrointestinal reactions, drowsiness） of observation group was significantly lower than the control group （P〈0.05）. Conclusion Celebrex preemptive analgesia before surgery can relieve pain after lumbar discectomy, which has good curative effect and little side effect.