【摘要】：目的：觀察COX-2抑制劑在全膝關(guān)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(guān)節(jié)置換術(shù)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(shù)前2h口服塞來昔布400mg,術(shù)后6h再給予200mg口服,此后14d口服塞來昔布200mg Bid,對照組于術(shù)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(cè)人工關(guān)節(jié)置換術(shù),術(shù)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(guān)節(jié)后方關(guān)節(jié)囊,內(nèi)、外側(cè)副韌帶周圍,股四頭肌伸肌裝置,髕韌帶組織,關(guān)節(jié)周圍脂肪及皮下組織注射鎮(zhèn)痛。嗎啡作為術(shù)后輔助鎮(zhèn)痛藥物。觀察指標：(1)術(shù)后12h、24h、2d、3d、5d、7d、14d靜息VAS評分；3d、5d、7d、14d運動VAS評分；(2)術(shù)后1d、2d、3d、5d、7d、14d膝關(guān)節(jié)活動度及主動屈膝到90。所需時間；(3)術(shù)前及術(shù)后1d、3d、5d、7d、14d、3月血清Hs-CRP;(4)術(shù)后1月、3月HSS評分；(5)術(shù)后48h內(nèi)阿片類藥物使用量及不良反應(yīng)記錄。數(shù)據(jù)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(jié)果： ①在置換后12h、24h、2d、3d、5d內(nèi),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(shù)前Hs-CRP之間無顯著差異(P0.05),但術(shù)后1d、3d、5d、7d、14d,實驗組較對照組明顯降低(P0.05),術(shù)后3月隨訪兩組之間無顯著差異(P0.05)。 ③實驗組膝關(guān)節(jié)活動度在術(shù)后14d內(nèi)較對照組明顯改善(P0.05),術(shù)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(shù)后隨訪,兩組HSS評分未見差異(P0.05)。 ④實驗組48h內(nèi)阿片類藥物使用量較對照組明顯降低(P0.05),兩組不良反應(yīng)發(fā)生率相似,未見明顯差異(P0.05)。 結(jié)論：①COX-2抑制劑超前鎮(zhèn)痛可以顯著降低術(shù)后疼痛,改善近期關(guān)節(jié)功能,但對遠期關(guān)節(jié)功能無影響。②COX-2抑制劑超前鎮(zhèn)痛可以顯著降低術(shù)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(dǎo)表達的程度明顯降低。③COX-2抑制劑超前鎮(zhèn)痛可以減少術(shù)后阿片類藥物的使用量,降低術(shù)后不良反應(yīng)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(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

【參考文獻】

相關(guān)期刊論文 前10條

1 李樹叢;張書利;;中藥經(jīng)皮給藥治療疼痛臨床研究[J];安徽中醫(yī)學(xué)院學(xué)報;2012年03期

2 陳志成;張貴鋒;黃泳;王升旭;;基于SF-MPQ評價溫針灸合用中藥外洗對膝關(guān)節(jié)炎疼痛干預(yù)的研究[J];長春中醫(yī)藥大學(xué)學(xué)報;2011年02期

3 姜宏，，楊志良;穴位指壓推拿治療腰腿痛的鎮(zhèn)痛療效觀察與研究[J];頸腰痛雜志;1994年01期

4 單海華;朱常花;謝紅;王琛;;超聲引導(dǎo)下連續(xù)股神經(jīng)阻滯用于全膝關(guān)節(jié)置換術(shù)后的鎮(zhèn)痛效果[J];臨床麻醉學(xué)雜志;2012年08期

5 仲霄鵬;朱慶生;朱錦宇;上官磊;;全膝關(guān)節(jié)置換術(shù)后多模式鎮(zhèn)痛中非選擇與選擇性COX-2抑制劑的對比應(yīng)用研究[J];現(xiàn)代生物醫(yī)學(xué)進展;2011年04期

6 王世英;孔玲;畢光焰;魏光武;;硬膜外鎮(zhèn)痛與靜脈鎮(zhèn)痛對老年下肢關(guān)節(jié)置換及植入物內(nèi)固定治療后早期認知功能的影響[J];中國組織工程研究與臨床康復(fù);2011年35期

7 李振林;高東艷;;帕瑞昔布鈉超前鎮(zhèn)痛對髖關(guān)節(jié)置換術(shù)患者血清IL-6和IL-10的影響[J];中國醫(yī)療前沿;2011年20期

8 高升燾;孫愛娟;張鵬;萬連平;杜建春;;全膝關(guān)節(jié)置換術(shù)后應(yīng)用連續(xù)股神經(jīng)阻滯鎮(zhèn)痛和靜脈自控鎮(zhèn)痛的效果比較[J];中華關(guān)節(jié)外科雜志(電子版);2012年01期

9 楊林;郭艾;徐本明;丁燁;;西樂葆超前鎮(zhèn)痛在髖關(guān)節(jié)置換手術(shù)的應(yīng)用[J];中國矯形外科雜志;2007年14期

10 李麗;羅曼;馮潔;耿立成;;連續(xù)股神經(jīng)阻滯鎮(zhèn)痛對老年人全膝關(guān)節(jié)置換術(shù)后康復(fù)功能的影響[J];中國矯形外科雜志;2009年15期

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