本文選題：塞來(lái)昔布 + 人工關(guān)節(jié)置換術(shù)��； 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:本研究在超前鎮(zhèn)痛用藥的時(shí)間和劑量選擇上進(jìn)一步探索,以明確塞來(lái)昔布在超前鎮(zhèn)痛中的更佳服藥方式。同時(shí),對(duì)口服塞來(lái)昔布聯(lián)合靜脈自控鎮(zhèn)痛(Patient-controlled intravenous analgesia,PCIA)在人工關(guān)節(jié)置換術(shù)后鎮(zhèn)痛的效果及安全性作一研究,為后期制定規(guī)范化、個(gè)體化鎮(zhèn)痛方案提供依據(jù)。方法:選取擇期行單側(cè)全膝、髖人工關(guān)節(jié)置換手術(shù)的患者60例,隨機(jī)分為A、B、C三組,每組20例。A組患者術(shù)前3天,開始服用塞來(lái)昔布(200mg/次,Bid);B組患者術(shù)前3~4小時(shí),400mg塞來(lái)昔布,5ml水頓服;C組患者(術(shù)后鎮(zhèn)痛組)術(shù)前不使用任何止痛藥物。所有患者術(shù)后均使用靜脈止痛泵(舒芬太尼100μg,托烷司瓊15mg,氟比洛芬酯100mg,100ml生理鹽水稀釋)持續(xù)鎮(zhèn)痛48h,術(shù)后6小時(shí)患者可以進(jìn)食后口服200mg塞來(lái)昔布,術(shù)后第1日開始,200mg/次,2次/日,至術(shù)后5-8天(由患者疼痛程度決定)。疼痛難以忍受時(shí)靜注注射用帕瑞昔布或者氟比洛芬酯(FA)注射液。觀察項(xiàng)目主要包括:1.每例患者術(shù)前2h,術(shù)后4h、8h、12h、24h、48h、72h疼痛VAS評(píng)分;2.每組患者發(fā)生傷口延遲愈合、惡心嘔吐、腹痛腹瀉、頭痛頭暈等藥物不良反應(yīng)的例數(shù);3.各組追加止痛藥增強(qiáng)療效的例數(shù);4.每例患者術(shù)中及術(shù)后總的出血量(術(shù)后主要記錄每日引流量至引流管拔除)。結(jié)果:術(shù)前各組患者疼痛VAS評(píng)分及其它一般情況無(wú)明顯統(tǒng)計(jì)學(xué)差異;術(shù)后3天各時(shí)間點(diǎn)疼痛評(píng)分A組明顯低于C組(P㩳0.05),但A組與B組、B組與C組之間無(wú)顯著性差異;術(shù)后各組藥物援助率、不良反應(yīng)發(fā)生率及總出血量間無(wú)顯著差異。結(jié)論:圍手術(shù)期口服塞來(lái)昔布合并靜脈自控鎮(zhèn)痛對(duì)于人工關(guān)節(jié)置換患者的早期鎮(zhèn)痛效果確切,術(shù)前3天開始用藥能在術(shù)后獲得更佳的鎮(zhèn)痛效果,不會(huì)引起不良反應(yīng)及出血量的明顯增加。
[Abstract]:Objective: to further explore the time and dosage selection of preemptive analgesia in order to clarify the better medication of celecoxib in preemptive analgesia. At the same time, the efficacy and safety of oral celecoxib combined with Patient-controlled intravenous analgesia (Patient-controlled intravenous analgesia) after artificial joint replacement were studied. Methods: sixty patients undergoing unilateral total knee arthroplasty and hip arthroplasty were randomly divided into three groups: group A (n = 20), group A (n = 20), and group A (n = 20). Patients in group B were given celecoxibul 200mg / d for 3 hours and 400mg celecoxib 5ml before operation. Group C (postoperative analgesia group) did not use any painkillers before operation. All patients were treated with intravenous analgesic pump (sufentanil 100 渭 g, tropisetron 15 mg, flurbiprofen 100 mg / 100ml saline dilution) for 48 h. Patients could take 200mg celecoxib 6 hours after operation. Up to 5-8 days postoperatively (depending on the patient's pain level). When pain is unbearable, intravenous injection of pareoxib or flurbiprofen (FAA) injection. The observation items mainly include: 1. The VAS score of pain 2 hours before operation and 4 hours after operation was 12 hours, 24 hours, 48 hours and 72 hours after operation. Patients in each group experienced delayed wound healing, nausea and vomiting, abdominal pain, diarrhea, headache, dizziness and other adverse drug reactions. The number of patients in each group who added analgesic to enhance the curative effect was 4. The total amount of blood loss during and after operation (daily drainage to drainage tube extubation was recorded after operation. Results: there was no significant difference in pain VAS score and other general conditions in each group before operation, and the pain score in group A was significantly lower than that in group C at each time point 3 days after operation, but there was no significant difference between group A and group B and group C. There was no significant difference in the rate of drug aid, the incidence of adverse reactions and the total amount of blood loss. Conclusion: oral celecoxib combined with patient-controlled intravenous analgesia in perioperative period is effective for early analgesia in patients with artificial joint replacement. 3 days before operation, a better analgesic effect can be obtained after operation. There is no significant increase in adverse reactions and bleeding.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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本文編號(hào)：1842138