依托考昔超前镇痛联合甲强龙对全髋关节置换术后患者早期康复影响的研究

Effect of preemptive analgesia using etoricoxib combined with methylprednisolone on early rehabilitation after total hip replacement

目的分析依托考昔超前镇痛联合甲强龙对全髋关节置换术患者术后早期康复的影响。方法于2019年1-12月,将本院收治的因髋关节慢性疾病行全髋关节置换术患者70例分为观察组和对照组。观察组于手术前晚口服依托考昔60 mg,术中静脉推注甲强龙40 mg;对照组术前及术中均不使用依托考昔和甲强龙。术后5 d内,所有患者规律服用依托考昔60毫克/次,每天1次。分析患者麻醉方式、手术时间、术中出血量等手术一般情况。分析患者住院时间、视觉模拟疼痛评分(VAS评分)、髋关节功能Harris评分以评价临床疗效;比较患者术后谵妄、胃肠道症状(如恶心、呕吐)和大小便困难(尿潴留、便秘)等不良反应发生情况以评价安全性。结果患者麻醉方式、手术时间、术中出血量组间比较差异无统计学意义(P>0.05)。观察组患者住院时间短于对照组(P<0.05)。观察组患者术后12 h、24 h VAS评分低于对照组(P<0.05),术后3 d、5 d VAS评分组间比较差异无统计学意义(P>0.05)。观察组术后24 h Harris评分高于对照组(P<0.05),术后5 d和1个月Harris评分组间比较差异无统计学意义(P>0.05)。患者术后谵妄、胃肠道症状(如恶心、呕吐)和大小便困难(尿潴留、便秘)等不良反应发生率比较差异无统计学意义(P>0.05)。结论依托考昔超前镇痛联合应用甲强龙可实现全髋关节置换手术患者术后有效镇痛,术后不良反应少,有助于患者术后早期康复。

Objective To explore the effect of preemptive analgesia using etoricoxib combined with methylprednisolone on early rehabilitation after total hip replacement(THR).Methods Seventy patients,treated in this hospital between Jan.and Dec.2019,were randomly divided into two groups.Patients in observation group were orally medicated 60 mg etoricoxib at night before the day of THR operation,and were given 40 mg methylprednisolone intravenously during operation.Neither etoricoxib nor methylprednisolone was used in patients in control group.All patients in both two groups were given etoricoxib 60 mg once a day within 5 days after operation.General situation of operation,including anesthesia mode,operation time and intraoperative bleeding were analyzed.Clinical effect was evaluated by analyzing the hospitalization time,VAS pain score and Harris score of hips.The adverse reactions of delirium,nausea and vomiting were observed to evaluate the security.Results There was no significant difference in anesthesia mode,operation time and intraoperative bleeding between the two groups.The average length of stay in the observation group was significantly lower than that in the control group(P<0.05).The VAS score in observation group was significantly lower than that in control group at 12 h and 24 h postoperatively(P<0.05).Although the VAS score in observation group was lower than that in control group at 3 and 5 days postoperatively,there was no significant difference between the two groups(P>0.05).The Harris score of the observation group on the first day after operation was higher than that of the control group(P<0.05),while Harris score on the fifth day and the first month after operation was also higher than that of the control group,but there was not statistically significant(P>0.05).There was postoperative delirium,gastrointestinal symptoms(such as nausea and vomiting)and difficulty in defecation(urinary retention and constipation),but there was no significant difference between the two groups(P>0.05).Conclusion The multi-mode treatment based on the combination of etoricoxib and methylprednisolone can provide satisfactory postoperative analgesia after total hip replacement,with less adverse reactions during perioperative period,which can promote the early recovery of patients.