COX-2抑制剂在全膝关节置换超前镇痛中的有效性及对Hs-CRP的影响
发布时间：2018-08-18 17:54
【摘要】：目的：观察COX-2抑制剂在全膝关节置换超前镇痛中的有效性以及对Hs-CRP的影响 方法：选择行全膝关节置换术患者60例,年龄55-75岁,男13例,女47例,随机分为实验组(鸡尾酒镇痛十超前镇痛)和对照组(鸡尾酒镇痛),实验组术前2h口服塞来昔布400mg,术后6h再给予200mg口服,此后14d口服塞来昔布200mg Bid,对照组于术后常规口服塞来昔布200mg Bid,所有患者均在硬膜外麻醉下行单侧人工关节置换术,术中给予“鸡尾酒”100m1(吗啡5mg+甲磺酸罗哌卡因150mg+酮咯酸30mg+肾上腺素0.3mg+生理盐水)对膝关节后方关节囊,内、外侧副韧带周围,股四头肌伸肌装置,髌韧带组织,关节周围脂肪及皮下组织注射镇痛。吗啡作为术后辅助镇痛药物。观察指标：(1)术后12h、24h、2d、3d、5d、7d、14d静息VAS评分；3d、5d、7d、14d运动VAS评分；(2)术后1d、2d、3d、5d、7d、14d膝关节活动度及主动屈膝到90。所需时间；(3)术前及术后1d、3d、5d、7d、14d、3月血清Hs-CRP;(4)术后1月、3月HSS评分；(5)术后48h内阿片类药物使用量及不良反应记录。数据分析采用SPSS20.0统计软件,组间比较采用独立样本t检验,检验水准P=0.05。 结果： ①在置换后12h、24h、2d、3d、5d内,实验组静息VAS评分较对照组明显降低(P0.05),但在7d后两组之间无明显差异(P0.05)。实验组与对照组在运动VAS评分上无显著差异(P0.05)。 ②实验组与对照组术前Hs-CRP之间无显著差异(P0.05),但术后1d、3d、5d、7d、14d,实验组较对照组明显降低(P0.05),术后3月随访两组之间无显著差异(P0.05)。 ③实验组膝关节活动度在术后14d内较对照组明显改善(P0.05),术后1月两组之间无显著性差异(P0.05),实验组主动屈膝达到90。所需时间与对照组之间有显著差异(P0.05)。术后随访,两组HSS评分未见差异(P0.05)。 ④实验组48h内阿片类药物使用量较对照组明显降低(P0.05),两组不良反应发生率相似,未见明显差异(P0.05)。 结论：①COX-2抑制剂超前镇痛可以显著降低术后疼痛,改善近期关节功能,但对远期关节功能无影响。②COX-2抑制剂超前镇痛可以显著降低术后炎性因子的释放,改善组织炎症程度,使得Hs-CRP受炎性因子诱导表达的程度明显降低。③COX-2抑制剂超前镇痛可以减少术后阿片类药物的使用量,降低术后不良反应的发生率。
[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.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2190238
[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.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前10条
1 李树丛;张书利;;中药经皮给药治疗疼痛临床研究[J];安徽中医学院学报;2012年03期
2 陈志成;张贵锋;黄泳;王升旭;;基于SF-MPQ评价温针灸合用中药外洗对膝关节炎疼痛干预的研究[J];长春中医药大学学报;2011年02期
3 姜宏，，杨志良;穴位指压推拿治疗腰腿痛的镇痛疗效观察与研究[J];颈腰痛杂志;1994年01期
4 单海华;朱常花;谢红;王琛;;超声引导下连续股神经阻滞用于全膝关节置换术后的镇痛效果[J];临床麻醉学杂志;2012年08期
5 仲霄鹏;朱庆生;朱锦宇;上官磊;;全膝关节置换术后多模式镇痛中非选择与选择性COX-2抑制剂的对比应用研究[J];现代生物医学进展;2011年04期
6 王世英;孔玲;毕光焰;魏光武;;硬膜外镇痛与静脉镇痛对老年下肢关节置换及植入物内固定治疗后早期认知功能的影响[J];中国组织工程研究与临床康复;2011年35期
7 李振林;高东艳;;帕瑞昔布钠超前镇痛对髋关节置换术患者血清IL-6和IL-10的影响[J];中国医疗前沿;2011年20期
8 高升焘;孙爱娟;张鹏;万连平;杜建春;;全膝关节置换术后应用连续股神经阻滞镇痛和静脉自控镇痛的效果比较[J];中华关节外科杂志(电子版);2012年01期
9 杨林;郭艾;徐本明;丁烨;;西乐葆超前镇痛在髋关节置换手术的应用[J];中国矫形外科杂志;2007年14期
10 李丽;罗曼;冯洁;耿立成;;连续股神经阻滞镇痛对老年人全膝关节置换术后康复功能的影响[J];中国矫形外科杂志;2009年15期
本文编号：2190238
本文链接：https://www.wllwen.com/yixuelunwen/mazuiyixuelunwen/2190238.html
最近更新
教材专著
