【摘要】：目的：觀察COX-2抑制劑在全膝關節(jié)置換超前鎮(zhèn)痛中的有效性以及對Hs-CRP的影響 方法：選擇行全膝關節(jié)置換術患者60例,年齡55-75歲,男13例,女47例,隨機分為實驗組(雞尾酒鎮(zhèn)痛十超前鎮(zhèn)痛)和對照組(雞尾酒鎮(zhèn)痛),實驗組術前2h口服塞來昔布400mg,術后6h再給予200mg口服,此后14d口服塞來昔布200mg Bid,對照組于術后常規(guī)口服塞來昔布200mg Bid,所有患者均在硬膜外麻醉下行單側人工關節(jié)置換術,術中給予“雞尾酒”100m1(嗎啡5mg+甲磺酸羅哌卡因150mg+酮咯酸30mg+腎上腺素0.3mg+生理鹽水)對膝關節(jié)后方關節(jié)囊,內、外側副韌帶周圍,股四頭肌伸肌裝置,髕韌帶組織,關節(jié)周圍脂肪及皮下組織注射鎮(zhèn)痛。嗎啡作為術后輔助鎮(zhèn)痛藥物。觀察指標：(1)術后12h、24h、2d、3d、5d、7d、14d靜息VAS評分；3d、5d、7d、14d運動VAS評分；(2)術后1d、2d、3d、5d、7d、14d膝關節(jié)活動度及主動屈膝到90。所需時間；(3)術前及術后1d、3d、5d、7d、14d、3月血清Hs-CRP;(4)術后1月、3月HSS評分；(5)術后48h內阿片類藥物使用量及不良反應記錄。數據分析采用SPSS20.0統(tǒng)計軟件,組間比較采用獨立樣本t檢驗,檢驗水準P=0.05。 結果： ①在置換后12h、24h、2d、3d、5d內,實驗組靜息VAS評分較對照組明顯降低(P0.05),但在7d后兩組之間無明顯差異(P0.05)。實驗組與對照組在運動VAS評分上無顯著差異(P0.05)。 ②實驗組與對照組術前Hs-CRP之間無顯著差異(P0.05),但術后1d、3d、5d、7d、14d,實驗組較對照組明顯降低(P0.05),術后3月隨訪兩組之間無顯著差異(P0.05)。 ③實驗組膝關節(jié)活動度在術后14d內較對照組明顯改善(P0.05),術后1月兩組之間無顯著性差異(P0.05),實驗組主動屈膝達到90。所需時間與對照組之間有顯著差異(P0.05)。術后隨訪,兩組HSS評分未見差異(P0.05)。 ④實驗組48h內阿片類藥物使用量較對照組明顯降低(P0.05),兩組不良反應發(fā)生率相似,未見明顯差異(P0.05)。 結論：①COX-2抑制劑超前鎮(zhèn)痛可以顯著降低術后疼痛,改善近期關節(jié)功能,但對遠期關節(jié)功能無影響。②COX-2抑制劑超前鎮(zhèn)痛可以顯著降低術后炎性因子的釋放,改善組織炎癥程度,使得Hs-CRP受炎性因子誘導表達的程度明顯降低。③COX-2抑制劑超前鎮(zhèn)痛可以減少術后阿片類藥物的使用量,降低術后不良反應的發(fā)生率。
[Abstract]:Objective: to observe the efficacy of COX-2 inhibitor in preemptive analgesia of total knee arthroplasty and its influence on Hs-CRP. Methods: sixty patients with total knee arthroplasty, aged 55-75 years, 13 males and 47 females, were selected. They were randomly divided into experimental group (cocktail analgesia + preemptive analgesia) and control group (cocktail analgesia). The experimental group was given celecoxib 400 mg 2 h before operation and 200mg was given 6 h after operation. After 14 days, celecoxib 200mg Bidid was given orally, while the control group took celecoxib 200mg Bidid.All the patients underwent unilateral artificial joint replacement under epidural anesthesia. Intraoperative administration of "cocktail" 100m1 (morphine 5mg mesylate ropivacaine 150mg keto 30mg epinephrine normal saline) on posterior articular capsule, medial and lateral collateral ligament of knee joint, extensor muscle device of quadriceps femoris, patellar ligament tissue, Periarticular fat and subcutaneous tissue injection analgesia. Morphine was used as an adjuvant analgesic after operation. Observation measures: (1) 12 h after operation, 24 h, 2 h, 3 d, 3 d, 5 d, 7 d, 14 d rest VAS score and 3 d, 5 d, 7 d, 14 d VAS, (2) 1 day, 2 d, 3 d, 7 d, 14 d, and active knee flexion to 90 d. The time required, (3) before and 1 day after operation, 3 days, 5 days, 7 days, 14 days, 3 months serum Hs-CRP, (4) 1 month, 3 months HSS score, (5) opioid drug usage and adverse reaction record within 48 hours after operation. SPSS20.0 statistical software was used to analyze the data, and independent sample t test was used to test the level of P0. 05. Results: 1within 12 h, 24 h, 2 h and 3 d after replacement, the VAS score of the experimental group was significantly lower than that of the control group (P0.05), but there was no significant difference between the two groups after 7 days (P0.05). There was no significant difference in exercise VAS score between the experimental group and the control group (P0.05). 2 there was no significant difference between the experimental group and the control group in preoperative Hs-CRP score (P0.05), but there was no significant difference between the experimental group and the control group on the 1st day, 3d, 5d, 7d and 14d after operation (P0.05), and there was no significant difference between the two groups at 3 months after operation (P0.05). Significant difference (P0.05). 3 the knee motion in the experimental group within 14 days after operation significantly improved compared with the control group (P0.05), there was no significant difference between the two groups after one month (P0.05), the experimental group reached 90. There was a significant difference between the time required and the control group (P0.05). There was no difference in HSS score between the two groups (P0.05). 4 the usage of opioid drugs in the experimental group was significantly lower than that in the control group within 48 hours (P0.05), and the incidence of adverse reactions in the two groups was similar (P0.05). Conclusion 1 COX-2 inhibitor preemptive analgesia can significantly reduce postoperative pain and improve short-term joint function, but has no effect on long-term joint function. 2 COX-2 inhibitor preemptive analgesia can significantly reduce postoperative inflammatory factor release. Improving the degree of tissue inflammation and reducing the expression of Hs-CRP induced by inflammatory factors could reduce the usage of opioid drugs and the incidence of postoperative adverse reactions.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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