塞来昔布用于关节置换术后超前镇痛的临床研究

发布时间：2018-05-04 07:30

本文选题：塞来昔布 + 人工关节置换术　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:本研究在超前镇痛用药的时间和剂量选择上进一步探索,以明确塞来昔布在超前镇痛中的更佳服药方式。同时,对口服塞来昔布联合静脉自控镇痛(Patient-controlled intravenous analgesia,PCIA)在人工关节置换术后镇痛的效果及安全性作一研究,为后期制定规范化、个体化镇痛方案提供依据。方法:选取择期行单侧全膝、髋人工关节置换手术的患者60例,随机分为A、B、C三组,每组20例。A组患者术前3天,开始服用塞来昔布(200mg/次,Bid);B组患者术前3~4小时,400mg塞来昔布,5ml水顿服;C组患者(术后镇痛组)术前不使用任何止痛药物。所有患者术后均使用静脉止痛泵(舒芬太尼100μg,托烷司琼15mg,氟比洛芬酯100mg,100ml生理盐水稀释)持续镇痛48h,术后6小时患者可以进食后口服200mg塞来昔布,术后第1日开始,200mg/次,2次/日,至术后5-8天(由患者疼痛程度决定)。疼痛难以忍受时静注注射用帕瑞昔布或者氟比洛芬酯(FA)注射液。观察项目主要包括:1.每例患者术前2h,术后4h、8h、12h、24h、48h、72h疼痛VAS评分;2.每组患者发生伤口延迟愈合、恶心呕吐、腹痛腹泻、头痛头晕等药物不良反应的例数;3.各组追加止痛药增强疗效的例数;4.每例患者术中及术后总的出血量(术后主要记录每日引流量至引流管拔除)。结果:术前各组患者疼痛VAS评分及其它一般情况无明显统计学差异;术后3天各时间点疼痛评分A组明显低于C组(P㩳0.05),但A组与B组、B组与C组之间无显着性差异;术后各组药物援助率、不良反应发生率及总出血量间无显著差异。结论:围手术期口服塞来昔布合并静脉自控镇痛对于人工关节置换患者的早期镇痛效果确切,术前3天开始用药能在术后获得更佳的镇痛效果,不会引起不良反应及出血量的明显增加。
[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.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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