帕瑞昔布钠术前预处理对全膝关节置换术术后镇痛与炎性因子影响.docVIP

帕瑞昔布钠术前预处理对全膝关节置换术术后镇痛与炎性因子影响 　　[摘要] 目的 观察帕瑞昔布钠术前预处理对全膝关节置换术（TKA）术后镇痛及炎性因子的影响。 方法 选择2014年1月～2015年6月间收治的104例行TKA的骨性关节炎患者随机分为观察组（54例）和对照组（50例），观察组麻醉诱导前30 min静脉注射40 mg帕瑞昔布钠，对照组不进行预处理，两组麻醉方法均为喉罩插管静吸复合全身麻醉。采用视觉模拟评分法（VAS法）评估患者术前与术后不同时点静息状态下疼痛程度，记录术后48 h内自控镇痛泵（PCA）按压次数与盐酸曲马多注射液使用量，此外，术前与术后不同时点采血检测外周血炎性因子水平。 结果 观察组术后4 h、8 h、12 h VAS评分均显著低于对照组（P0.05）。 结论TKA术前患者采用帕瑞昔布钠预处理能明显增强术后24 h镇痛水平，减少镇痛药用量，并能有效减轻术后炎性应激反应。 　　[关键词] 全膝关节置换术；帕瑞昔布钠；镇痛；视觉模拟评分；炎性因子 　　[中图分类号] R614；R687.4 [文献标识码] B [文章编号] 1673-9701（2016）09-0099-04 　　[Abstract] Objective To observe effects of preoperative parecoxib sodium pretreatment on postoperative analgesia and inflammatory factors for TKA patients. Methods A total of 104 osteoarthritis patients who underwent TKA from January 2014 to June 2015 were selected and randomly divided into the observation group （n=54） and control group （n=50）， and patients in the observation group were injected intravenously with 40 mg parecoxib sodium at 30 min before anesthesia induction， control group without pretreatment， the anesthetic method of two groups was Laryngeal mask intubation inhalation composite general anesthesia. Visual analogue scale（VAS） was used to evaluate patients pain degree preoperatively and postoperatively under surprise status at different time points， and pump controlled analgesia（PCA） pressing frequence and tramadol hydrochloride usage within 48 h after operation were recorded. In addition， peripheral inflammatory factor levels on different observing point were examined and compared. Results The postoperative VAS scores of the observation group were significantly higher than those of the control group 4 h， 8 h， 12 h（P0.05）. Conclusion TKA patients received parecoxib sodium pretreatment can significantly enhance analgesic efficacy within 24 h postoperatively， reduce analgesics dosage， and can effectively reduce postoperative inflammatory stress response. 　　[Key words] Total knee arthroplasty； Parecoxib sodium； Analgesia； Visual analogue scale； Infl