围手术期口服塞来昔布用于膝部骨折内固定术镇痛的研究

目的观察围手术期口服塞来昔布对膝部骨折内固定术术后疼痛评分、镇痛药物的使用、睡眠情况、不良反应及膝关节活动范围的影响。方法病人随机分为2组，每组20例，实验组术前3d起给予塞来昔布200mg口服，2次／d，持续至术后7d；对照组术前给予复合维生素片，术后予塞来昔布200rag口服，2次／d，持续至术后7d。术毕2组均使用静脉自控镇痛48h，术后2、4、8、16、24、48h采用视觉模拟评分（VAS）评价患者疼痛程度，调查患者睡眠满意度和不良反应情况，记录术后每日芬太尼用量，及术后2厨膝关节活动度。结果2组间用药前VAS疼痛评分差异无统计学意义（P〉0．05），但术后实验组各个时点的VAS值均低于对照组相应的VAS值（P〈0．05）；实验组术后睡眠满意度高于对照组（P〈0．01），术后24h需要芬太尼剂量低于对照组（P〈0.05），不良反应与对照组无明显区别（P〉0．05），出院时膝关节活动度大于对照组（P〈0．05）。结论围手术期使用塞来昔布用于膝部骨折手术具超前镇痛作用，能有效缓解术后疼痛，减少术后镇痛药的使用，改善睡眠满意度，改善膝关节活动范围，有利于膝关节功能恢复。

Effects of perioperative administration of celecoxib in patients underwent treatment of fractures around the knee by Internal fixation

Objective To evaluate the effects of perioperative administration of celecoxib in patients underwent treatment of fractures around the knee by internal fixation. Methods Forty patients scheduled for treatment of fractures around the knee by internal fixation were randomly divided into celecoxib group (group C)and placebo group (group P) with 20 cases in each group. Celecoxib 200mg or placebo was given in group C or P twice daily for 3 days before surgery. All patients were given celecoxib 200mg twice daily for 7 days and patient-controlled intravenous Analgesia ( PCIA ) for 48 h after surgery. Pain extent was evaluated using visual analog scale (VAS) after operation. The analgesic requirements, side effects, knee joint ranges of motion,sleep states were compared. Results There were no marked differences in the VAS pain scores before celecoxib administration between 2 groups. Compared with group P, the patients of group C had lower VAS pain scores after the operation ( P < 0.05). Compared with group P, a lower total consumption of other analgesics was observed in patients of group C for first 24 hours after the operation ( P <0.01). It was also found that the sleep satisfaction scores in group C were higher than that in group P ( P < 0.05). There were no significant differences in respect to the side effects between 2 groups ( P > 0.05). A larger hip joint ranges of motion was observed in patients of group C that group P ( P < 0.05). Conclusion Perioperative administration of celecoxib in patients undergoing the treatment of fractures around the knee by internalfixation can alleviate the postoperative pain score, reduce postoperative other analgesics consumption, meantime, it can improve knee joint ranges of motion and sleep states.