帕瑞昔布钠超前镇痛对人工膝关节置换膝骨关节炎的效果

Effect of preemptive analgesia with parecoxib sodium in patients with knee osteoarthritis after artificial knee replacement

目的分析帕瑞昔布钠超前镇痛对人工膝关节置换膝骨关节炎的效果。方法以收治的96例膝骨关节炎患者为研究对象,用随机抽签法分为常规麻醉组(48例)和超前镇痛组(48例)。所有患者均进行人工膝关节置换治疗,常规麻醉组麻醉前(t_(0))注射生理盐水,超前镇痛组t_(0)注射帕瑞昔布钠进行超前镇痛,2组围手术期均给予综合干预,2组患者术后均观察48 h。比较2组患者t_(0)、插管时(t_(1))、手术结束时(t_(2))、拔管时(t_(3))及拔管5 min后(t_(4))的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)及t_(0)、术后12 h(t_(5))、术后24 h(t_(6))及术后48 h(t_(7))的疼痛情况、膝关节功能,统计2组观察期中不良反应发生的情况。结果t_(0)、t_(1)、t_(2)、t_(3)、t_(4)时,2组患者的MAP、HR均呈先升高后降低的趋势;t_(1)、t_(2)、t_(3)时,超前镇痛组的MAP、HR低于常规麻醉组(P<0.05)。与t_(0)比较,2组患者t_(5)、t_(6)、t_(7)时的视觉模拟评分(visual analogue scale,VAS)均降低(P<0.05),超前镇痛组低于常规麻醉组(P<0.05)。与t_(0)比较,2组患者t_(5)、t_(6)、t_(7)时的美国特种外科医院量表(American special surgical hospital rating scale,HSS)评分均升高(P<0.05),超前镇痛组高于常规麻醉组(P<0.05)。术后观察期中,2组总不良反应发生率比较,差异无统计学意义。结论帕瑞昔布钠超前镇痛联合综合干预可有效缓解人工膝关节置换膝骨关节炎患者的应激反应和炎症反应,减轻术后疼痛,改善患者膝关节功能,具有较好的镇痛效果。

Objective To analyze the effect of preemptive analgesia with parecoxib sodium on knee osteoarthritis after artificial knee replacement.Methods 96 patients with knee osteoarthritis were randomly divided into routine anesthesia group(48 cases)and preemp-tive analgesia group(48 cases).All patients were treated with artificial knee replacement.Normal saline was injected into the routine anesthesia group at before anesthesia(t_(0)),and parecoxib sodium was injected into the preemptive analgesia group at t_(0) for preemptive analgesia.The both groups were given comprehensive intervention during perioperative period,and both groups were observed for 48 hours after operation.The mean arterial pressure(MAP),heart rate(HR)before anesthesia(t_(0)),at the time of intubation(t_(1)),at the end of operation(t_(2)),at the time of extubation(t_(3))and after extubation for 5 minutes(t_(4)),and preoperative pain and knee joint function t_(0) and t_(5),t_(6),t_(7) after operation were compared between the 2 groups,and the occurrence of adverse reactions were counted.Results At t_(0),t_(1),t_(2),t_(3) and t_(4),the MAP and HR of the 2 groups increased at first and then decreased at different time points.At t_(1),t_(2) and t_(3),the MAP and HR of the preemptive analgesia group were lower than those of the routine anesthesia group(P<0.05).At t_(5),t_(6) and t_(7) after operation,the visual analogue scale(VAS)of the 2 groups decreased compared with that t_(0) at different time points(P<0.05).At t_(5),t_(6) and t_(7) after operation,the scores of VAS in the preemptive analgesia group were lower than that of the routine anesthesia group(P<0.05).At t_(5),t_(6) and t_(7) after operation,the scores of American special surgical hospital rating scale(HSS)in the both groups increased compared with before operation at different time points(P<0.05).At t_(5),t_(6) and t_(7) after operation,the scores of HSS in the preemptive analgesia group were higher than the routine anesthesia group(P<0.05).During the postoperative observation period,there was no significant difference in the incidence of total adverse reactions between the 2 groups(P>0.05).Conclusion Preemptive analgesia with parecoxib sodium combined with comprehensive intervention could effectively relieve the stress and inflammatory reaction of patients with knee osteoarthritis after artificial knee replacement,reduce postoperative pain and improve the function of knee joint,which had a better analgesic effect.