帕瑞昔布+塞来昔布在全膝关节置换术后的序贯应用及疗效观察

Sequential treatment with parecoxib and celecoxib after primary total knee arthroplasty

[目的]研究在全膝关节置换术(TKA)后序贯应用帕瑞昔布+塞来昔布的临床疗效。[方法]纳入60例TKA患者,随机分成2组:试验组术后前3 d每12 h静脉注射帕瑞昔布40 mg,之后改为每12 h口服塞来昔布200mg至术后6周,对照组序贯使用生理盐水和相同外观的安慰剂。记录并比较两组患者术前及术后第1、2、3 d及1、2、4、6周静息及活动疼痛程度(VAS评分)、膝关节功能(HSS评分)、炎症指标值、不良反应发生率及术后2周内凝血功能指标值等。[结果]试验组术后前3 d静息VAS评分及术后各时间点活动VAS评分均显著低于对照组(P<0.05)。试验组术后1、2、4周膝关节HSS评分显著高于对照组(P<0.05),两组术后6周HSS评分差异无统计学意义。试验组术后各时间点血沉、术后1周内C反应蛋白、术后2周内IL-6、术后前3 d IL-8及TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。两组患者各时间点凝血指标差异无统计学意义(P>0.05),试验组术后住院天数及术后恶心呕吐发生率均显著低于对照组(P<0.05)。[结论]TKA术后序贯应用帕瑞昔布+塞来昔布镇痛效果满意,能促进术后早期关节功能康复、减轻术后早期炎症反应、缩短术后住院周期及减少不良反应发生率。

[Objective] To investigate the clinical efficacy of sequential treatment with parecoxib and celecoxib after primary total knee arthroplasty （TKA） . [Methods] Sixty patients undergoing primary and unilateral TKA were included, and randomly divided into the trial group （parecoxib ＋ celecoxib） and the control group （placebo） . The patients in the trial group accepted intravenous injection of parecoxib （40mg per 12 hours） in the first three postoperative days （POD）, and followed by oral celecoxib （200mg per 12 hours） until six weeks after surgery. The patients in the control group received placebo with the same dosages and courses as the trial group. The VAS pain scores, knee joint function status （HSS scores）, serum inflammatory cytokines levels, and adverse reactions at POD 1, 2, 3 and postoperative week （POW） 1, 2, 4 and 6, as well as the serum coagulation markers within the two weeks after surgery, were collected and compared between the two group. [Results] The VAS scores at rest （VASR） at POD 1, 2, 3, and the VAS scores at walking （VASW） at POD1 to POW6 in the trial group were significantly lower than those in the control group （P 〈 0.05） . The HSS scores in the trial group were statistically higher than that in the control group at POW 1, 2 and 4 （P〈 0.05）, however, no significant differences between the two groups were found at POW 6 （P 〉 0.05） . Additionally, erythrocyte sedimentation rate （ESR） from POD 1 to POW 6, CRP levels from POD 1 to POW 1, IL-6 levels from POD 1 to POW 2, IL-8 and TNF-α levels from PODI to POD 3 were significantly lower in the trial group than those in the control group （P〈 0.05） . There was no significant difference in the serum level of coagulation markers between the two groups （P 〉 0.05） . Furthermore, hospital stay, incidence of nausea and vomiting in the trial group were signifi- cantly lower than those in the control group （P 〈 0.05） . [Conclusions] Sequential treatment with parecoxib and ce- lecoxib is a safe and effective approach for postoperative pain management after primary TKA, it can alleviate post- operative pain and inflammatory response, promote the joint function recovery, shorten hospital stay, and reduce risk of adverse reactions.