塞来昔布联合右美托咪定超前镇痛对全膝关节置换术后疼痛的影响

Effect of Celecoxib Combined with Dexmedetomidine Preemptive Analgesia on Pain after Total Knee Arthroplasty

目的:研究塞来昔布联合右美托咪定超前镇痛对全膝关节置换术(total knee arthroplasty,TKA)后疼痛的影响。方法:选取2019年1—12月重钢总医院80例行全膝关节置换术的患者,随机分为:空白对照组(A组)、塞来昔布组(B组)、右美托咪定组(C组)、塞来昔布+右美托咪定组(D组),每组各20例。B组和D组患者从术前3 d开始予以口服塞来昔布预防镇痛,首次400 mg,然后200 mg/次,2次/d。手术当日麻醉诱导前20 min,C组和D组予以右美托咪定0.6μg/kg静脉泵入。A组不予处理。四组患者术后统一用患者自控镇痛(patient controlled analgesia,PCA)(含吗啡)。术后3 d,观察各组吗啡总用量、采用视觉模拟量表(visual analogue scale,VAS)测量和评估各组急性疼痛程度、采用膝关节活动度(range of motion,ROM)评估各组膝关节活动情况,以及各组运动情况。结果:术后3 d,D组吗啡总用量最低;D组VAS评分最低;D组ROM角度最大;D组运动能力最强。结论:塞来昔布联合右美托咪定超前镇痛对TKA具有良好的术后镇痛效果,效果明显优于塞来昔布或右美托咪定单药超前镇痛。

Objective:To study the effect of celecoxib combined with dexmedetomidine preemptive analgesia on pain after total knee arthroplasty(TKA).Methods:A total of 80 patients who underwent total knee arthroplasty in the hospital from January to De⁃cember 2019 were selected and randomly divided into blank control group(group A),celecoxib group(group B),dexmedetomidine group(group C),and celecoxib+dexmedetomidine group(group D),with 20 cases in each group.Patients in group B and group D were given oral celecoxib for prophylactic analgesia from 3 d before operation,the first 400 mg,then 200 mg/time,2 times/d.Twen⁃ty minutes before induction of anesthesia on the day of surgery,groups C and D were given dexmedetomidine 0.6μg/kg intrave⁃nously,and group A was not treated.Four groups of patients were treated with patient-controlled analgesia(PCA,containing mor⁃phine)after surgery.3 d after operation,the total amount of morphine in each group was observed.The Visual Analogue Scale(VAS)was used to measure and evaluate the acute pain level in each group.Range of motionv(ROM)was used to evaluate the ac⁃tivities of the knee joint in each group and the movement of each group.Results:3 d after operation,group D had the lowest total dosage of morphine,the lowest VAS score,the largest ROM angle,and the strongest exercise ability.Conclusion:Celecoxib com⁃bined with dexmedetomidine preemptive analgesia has a good postoperative analgesia effect on TKA,and the effect is significantly better than celecoxib or dexmedetomidine single drug preemptive analgesia.