帕瑞昔布钠在经皮椎体成形术中镇痛效果的临床研究

Clinical study on analgesic effect of parecoxib sodium in percutaneous vertebroplasty

目的观察帕瑞昔布钠在经皮椎体成形术中的镇痛效果。方法选取2017年7月至2019年6月重庆市大足区人民医院收治的骨质疏松症脊柱骨折患者200例,采用随机数字表法分为A组(术前30 min注射帕瑞昔布钠)、B组(术前30 min注射帕瑞昔布钠及盐酸哌替啶)、C组(盐酸哌替啶)和D组(对照组),每组50例。记录4组患者术前静息、活动时,术后6 h,术后3、7 d,术中给药后即刻(T0)、注入局部麻醉药后(T1)、穿刺针到达骨膜(T2)、注入骨水泥时(T3)各时间点视觉模拟疼痛量表(VAS)评分,观察4组患者不良反应发生情况,包括术中、术后24 h恶心、呕吐、寒战、精神症状(烦躁等)等。结果200例患者中男42例,女158例,女性发病率明显高于男性;平均年龄(73.02±7.35)岁,A组患者平均年龄(72.14±7.57)岁,B组患者平均年龄(72.74±7.97)岁,C组患者平均年龄(73.98±7.32)岁,D组患者平均年龄(73.22±6.56)岁。200例患者术后疼痛均明显缓解,术前活动时VAS评分与术后6 h,术后3、7 d比较,差异均有统计学意义(P<0.05);A、B组患者T2、T3 VAS评分均较C、D组明显改善,差异均有统计学意义(P<0.05)。A、B组患者T2、T3 VAS评分比较,差异均无统计学意义(P>0.05)。结论经皮椎体成形术是治疗老年性骨质疏松性骨折的有效方法,术前30 min使用帕瑞昔布钠可降低术中疼痛。

Objective To observe the analgesic effect of parecoxib sodium in percutaneous vertebroplasty(PVP).Methods A total of 200 patients with osteoporotic spinal fractures treated in the hospital from July 2017 to June 2019 were collected and divided into the group A(injected by parecoxib sodium at 30 min before operation),group B(injected by parecoxib sodium and pethidine hydrochloride at preoperative 30 min),group C(pethidine hydrochloride)and group D(control group)by adopting the random number table method.The VAS score at preoperative rest and activity,postoperative 6 h,3,7 d,immediately after intraoperative administration(T0),after injection of local anesthetic drug(T1),puncture to periosteum(T2)and injection of bone cement(T3)were recorded in 4 groups.The adverse reactions occurrence including nausea,vomit,chill and psychiatric symptoms(agitation,etc.)was observed in 4 groups.Results Among 200 patients,there were 42 males and 158 females.The incidence rate in female was significantly higher than that in male.The mean age was(73.02±7.35)years old.The mean age was(73.02±7.35),which in the group A was(72.14±7.57)year old,which in the group B was(72.74±7.97)year old,which in the group C was(73.98±7.32)year old and which in the group D was(73.22±6.56)year old.Postoperative pain in 200 cases was significantly relieved.The VAS score had statistical difference between before operation and at postoperative 6 h,3,7 d(P<0.05).The VAS score at T2,T3 in the group A and B were significantly improved compared with those in the group C and D,and the differences were statistically significant(P<0.05).The VAS score at T2,T3 had no statistical difference between the group A and B(P>0.05).Conclusion PVP is an effective treatment method for senile osteoporotic spinal fractures.Using parecoxib sodium at preoperative 30 min could reduce the intraoperative pain.