摘要
目的:观察时间治疗法服用塞来昔布在全膝关节置换手术后的镇痛效果。方法:于2005-08/2006-04选择沈阳军区总医院骨科收治的双侧全膝关节置换女性患者48例为观察对象,随机数字表法分为盐酸哌替啶肌注镇痛组,塞来昔布常规治疗组和塞来昔布时间治疗组,各组16例。患者均知情同意。盐酸哌替啶肌注镇痛组患者在术后疼痛并要求镇痛时肌注盐酸哌替啶50mg,每次间隔4h以上;塞来昔布常规治疗组患者术前8h口服塞来昔布(西乐葆,西尔大药厂波多黎各分厂,批号:0408064)400mg,术后禁食水期过后给予口服塞来昔布200mg,次日起按每日2次常规服药,期间可按患者要求给予肌注盐酸哌替啶50mg镇痛,每次间隔4h以上;塞来昔布时间治疗组患者术前3～7d每日通过目测类比评分法测定疼痛周期及峰值,术后在峰值时间前35min口服塞来昔布200mg,2次/d,对无明显疼痛周期的患者,参照Labrecque的研究结果确定服药时间。记录3组患者术后应用盐酸哌替啶肌注镇痛次数,术后12d疼痛目测类比评分,膝关节功能锻炼后的屈曲角度。结果:纳入患者48例,均进入结果分析。①塞来昔布常规治疗组、塞来昔布时间治疗组术后注射盐酸哌替啶镇痛次数明显低于盐酸哌替啶肌注镇痛组[以24～48h为例,分别为(0.750±0.173),(0.625±0.143),(1.125±0.121)次,P<0.05]。②功能锻炼同期患者疼痛目测类比评分盐酸哌替啶肌注镇痛组>塞来昔布常规治疗组>塞来昔布时间治疗组,组间差异有显著性意义(以术后第4天为例,分别为7,5,4分,P<0.05)。③塞来昔布时间治疗组在术后第6,7,9天时膝关节功能锻炼的屈曲角度高于塞来昔布常规治疗组、盐酸哌替啶肌注镇痛组,差异有显著性意义[以术后第6天为例,分别为(87±2)°,(76±2)°,(64±1)°,P<0.05]。结论:塞来昔布可提高患者围手术期痛阈,明显减少术后注射盐酸哌替啶镇痛的次数,缓解功能锻炼期关节疼痛。采用时间治疗法服用,可更为明显地降低患者功能锻炼期疼痛目测类比评分,并在一定程度上有利于更早达到功能锻炼目标。
AIM： To observe the analgesic effect of taking eelecoxib by time medicine method after total knee arthroplasty operation. METHODS： Forty-eight female patients underwent the total knee arthroplasty admitted in the Department of Orthopedics, General Hospital of Shenyang Military Area Command from August 2005 to April 2006 were selected and randomly divided into Pethidine Hydrochloride group, eeleeoxib routine treated group and eeleeoxib time medicine method group with 16 eases in each group, All patients were informed and agreed the study. The patients in the Pethidine Hydrochloride group were intramuscular injected with 50 mg Pethidine Hydrochloride with 4 hours or above intervals; eeleeoxib routine treated group was orally taken 400 mg eeleeoxib 8 hours before operation （Celebrex, produced by the Porto Rico Branch Factory of Searie Pharmaceutical Factory, No. 0408064） following by orally taken 200 mg eeleeoxib after starvation and water deprivation; and the patients took the medicine routinely from the next day and given intramuscular injected with 50 mg Pethidine Hydrochloride with 4 hours or above intervals if they required; the pain time and peak value of the eeleeoxib time medicine method group were measured with visual analog scale 3-7 days before operation; and 200 mg eeleeoxib was orally taken 35 minutes before reached peak value after operation, twice daily. The time to take medicine for those without definite pain time was determined by research results of Labrecque. The times injected Pethidine Hydrochloride of the 3 groups after operation, scores of the visual analog scale and the degree of flexion of knee after function exercise were recorded. RESULTS： All the 48 patients were involved in the result analysis. ①The times injected Pethidine Hydrochloride of the, celecoxib routine treated group and celecoxib time medicine method group were markedly lower than the Pethidine Hydrochloride group [during 24-48 hours, the times were （0.750±0.173）, （0.625±0.143）, （1.125±0.121）, P 〈 0.051. ②Visual analog scale of the patients under funetion exercise： Pethidine Hydrochloride group 〉 eeleeoxib routine treated group 〉 eeleeoxib time medieine method group, which had significant differences （at day 4 after operation, the scores were 7, 5 and 4, P 〈 0.05）. ③The degree of flexion of knee of eelecoxib time medicine method group was higher than the eeleeoxib routine treated group and Pethidine Hydrochloride group at day 6, 7 and 9 after operation, which had significant differences [at day 6, the degrees were （87±2）°, （76±2）°（64±1）°, P 〈 0.05]. CONCLUSION： Celeeoxib can enhance the limen of ache after operation, greatly reduce the times of Pethidine Hydroehloride injection and relieve the pain during function exercise period. Taking eeleeoxib by time medicine method can obviously depress the visual analog scale and is in favor of achieving the goal of funetion exercise early to a eertain extent.
出处
《中国临床康复》
CSCD
北大核心
2006年第48期39-41,共3页
Chinese Journal of Clinical Rehabilitation
