塞来昔布超前镇痛对人工全髋膝关节置换术后疼痛疗效的系统评价

Systematic Evaluation of Preemptive Analgesia with Celecoxib on Postoperative Pain in Total Hip Arthroplasty

目的:基于文献荟萃分析(Meta分析)方法,系统评价塞来昔布超前镇痛对人工全髋膝关节置换术后疼痛的疗效。方法:检索PubMed、EMBase、中国知网、维普数据库及万方数据库,纳入塞来昔布超前镇痛用于人工全髋膝关节置换术后疼痛的随机对照试验(观察组患者采用塞来昔布超前镇痛和术后镇痛方案,对照组患者采用单独术后镇痛泵或单独术后塞来昔布镇痛方案),提取数据并评价方法学质量,采用RevMan 5.3软件进行Meta分析。结果:最终纳入9篇文献,共616例患者。Meta分析结果显示,塞来昔布超前镇痛及术后镇痛与术后持续镇痛泵镇痛对人工全髋膝关节置换术后患者疼痛视觉模拟评分法(visual analogue scale,VAS)评分的影响的差异无统计学意义(MD=0.08,95%CI=-0.43~0.59,P=0.76);无论术后时间长短,塞来昔布超前镇痛对于人工全髋膝关节置换术后患者的VAS评分都有明显的影响(MD=-0.43,95%CI=-0.61^-0.26,P<0.0001);无论静息状态(MD=1.02,95%CI=0.14~1.91,P=0.02)还是活动状态(MD=0.67,95%CI=0.49~0.85,P<0.0001),塞来昔布超前镇痛及术后单独用药与联合其他镇痛药对人工全髋膝关节置换术后患者的VAS评分都有明显的影响,且术后联合其他药物镇痛的效果优于单独应用塞来昔布镇痛。结论:塞来昔布超前镇痛对人工全髋膝关节置换术后疼痛有确切疗效,且不受术后镇痛时间长短、静息状态及活动状态的影响,术后联合其他药物的镇痛效果更佳。

OBJECTIVE:To systematically evaluate the efficacy of preemptive analgesia with celecoxib on postoperative pain in total hip arthroplasty based on mata-analysis.METHODS:PubMed,EMbas,CNKI,VIP and Wanfang databases were retrieved to collect the clinical randomized controlled trial (RCT) of preemptive analgesia with celecoxib on postoperative pain in total hip arthroplasty (the observation group were given celecoxib preemptive analgesia and post-operative analgesia, while the control group were given celecoxib analgesia alone or with a single post-operative analgesia pump).Data were extracted and methodological quality was evaluated.RevMan 5.3 software was used for meta-analysis.RESULTS:Totally 9 literature were enrolled,including 616 patients.Meta-analysis results showed that there was no statistically significant difference in the effects of visual analogue scale (VAS) score on preemptive analgesia with celecoxib,postoperative analgesia and postoperative continuous analgesia of patients after total hip and knee arthroplasty( MD =0.08,95% CI =-0.43-0.59,P =0.76).Regardless of the length of postoperative period,preemptive analgesia with celecoxib had significant effects on the VAS score of patients after total hip arthroplasty( MD =-0.43,95% CI =-0.61--0.26,P <0.000 1).Regardless of the resting state ( MD =1.02,95% CI =0.14-1.91,P =0.02) or active state ( MD =0.67,95% CI =0.49-0.85,P <0.000 1),the effects of preemptive analgesia with celecoxib and postoperative medication alone with other analgesics on VAS score of patients with total hip arthroplasty was significant,and postoperative combined with other drug analgesia was better than celecoxib analgesia alone.CONCLUSIONS:Preemptive analgesia with celecoxib has a definite effect on pain after total hip arthroplasty,and is not affected by the length of postoperative analgesia,resting state and activity status.And postoperative analgesia effect is better when combined with other drugs.