帕瑞昔布超前镇痛联合硬膜外自控镇痛+鸡尾酒疗法用于髋关节置换术后镇痛临床研究

Effect of Parecoxib Preemptive Analgesia Combined with Patient-Controlled Epidural Analgesia and Cocktail Therapy on Postoperative Analgesia in Patients Undergoing Hip Replacement

目的探讨帕瑞昔布超前镇痛联合硬膜外自控镇痛+鸡尾酒疗法用于髋关节置换术后的镇痛效果。方法选取医院2017年6月至2019年6月收治拟行髋关节置换术的患者98例,随机分为观察组和对照组,各49例。两组患者均予硬膜外自控镇痛+鸡尾酒疗法,观察组患者加用帕瑞昔布超前镇痛。结果两组患者手术时间、苏醒时间、拔管时间、简易智力状态检查量表评分比较无显著差异(P> 0.05);与对照组比较,观察组患者术后2,4,8,12,24 h的视觉模拟评分均明显降低(P <0.05),术后的阿片类镇痛药物用量及自控镇痛总次数均明显减少(P <0.05),术后24 h的C反应蛋白、皮质醇、去甲肾上腺素水平均明显降低(P <0.05);观察组与对照组不良反应发生率相当(18.37%比12.24%,P> 0.05)。结论帕瑞昔布超前镇痛联合硬膜外自控镇痛+鸡尾酒疗法用于髋关节置换术后镇痛,能显著减轻术后的疼痛感,减少镇痛药物的用量,减轻术后的应激反应,且不影响患者的苏醒时间和认知功能。

Objective To investigate the effect of parecoxib preemptive analgesia combined with patient-controlled epidural analgesia(PCEA)and cocktail therapy on postoperative analgesia in patients undergoing hip replacement.Methods A total of 98 patients prepared to undergo hip replacement in our hospital from June 2017 to June 2019 were selected and randomly divided into the observation group and the control group,49 cases in each group.The patients in the two groups were treated with PCEA and cocktail therapy,on this basis,the patients in the observation group were treated with parecoxib preemptive analgesia.Results There was no significant difference in operation time,wake-up time,extubation time and the Mini-Mental State Examination(MMSE)score between the two groups(P>0.05).The visual analogue scale(VAS)score at 2,4,8,12,24 h after the operation in the observation group was significantly lower than that in the control group(P<0.05).The dosage of analgesics and total times of PCEA in the observation group were significantly lower than those in the control group(P<0.05).The levels of C-reactive protein,cortisol and noradrenaline at 24 h after the operation in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(18.37%vs.12.24%,P>0.05).Conclusion Parecoxib preemptive analgesia combined with PCEA and cocktail therapy for postoperative analgesia in patients undergoing hip replacement can significantly reduce postoperative pain,the dosage of analgesic drugs and the postoperative stress response without affecting the wake-up time and cognitive function of patients.