围手术期口服塞来昔布对全膝关节置换术后疼痛和功能康复的近期影响和安全性观察

目的 评价围手术期使用环氧合酶2抑制剂(塞来昔布)对全膝关节置换术后疼痛和功能康复的影响.方法 2005年1月至2006年2月,60例因骨关节炎或类风湿关节炎需行单侧全膝关节置换术患者被随机分为围手术期塞来昔布镇痛组(试验组)和术后塞来昔布镇痛组(对照组),每组30例.试验组从术前3 d开始口服塞来昔布,每天400 mg,持续至术后第5天;对照组从术后2 h开始口服塞来昔布,每天400 mg,持续至术后第5天.所有患者均由同一组医生完成手术,采用静脉-吸入复合麻醉,术毕给予患者自控静脉镇痛泵镇痛48 h.试验观测指标包括:术后止痛药用量、疼痛评分、不良反应发生率、功能康复时间、手术时间和术后引流量.结果 试验组术后48 h平均自控镇痛泵用量为(43±12)ml,低于对照组(53±12)ml(P<0.05).试验组术后4、8、12 h,1、2 d时膝关节疼痛评分为6.1±1.2、5.0±1.3、4.3±1.1、3.4±1.2,均明显低于对照组(P<0.05);术后3、4、5 d时膝关节疼痛评分,试验组与对照组间差异无统计学意义(P0.05).药物不良反应发生率、手术时间和术后引流量、术后盐酸哌替啶用量,试验组与对照组间差异无统计学意义(P0.05).术后膝关节主动屈曲90.所需的时间,试验组为(6.2±1.7)d,较对照组(8.6±1.8)d明显缩短(P<0.05).结论 围手术期使用塞来昔布具有超前镇痛作用,较单纯术后使用可明显减轻全膝关节置换术后早期疼痛,减少止痛药用量,加快关节功能康复,从而增加患者对手术的满意度.

Effects of perioperative administration of celecoxib on pain management and recovery of function after total knee replacement

Objective To assess the effect of perioperative administration of a selective cyclooxygermse 2 inhibitor (celecoxib) on pain management and recovery of function after total knee arthroplasty (TKA). Methods Randomized, controlled trial conducted from January 2005 through February 2006, 60 patients underwent TKA for osteoarthritis or rheumatoid arthritis were randomly divided into group of perioperative administration of celecoxib( Study group, n=30) and postoperative administration of celecoxib (Controll group, n=30). Patients in Study group were given oral celecoxib 3 d before TKA, 200 mg twice daily, and extended to 5 d postoperatively; patients in Controll group were given oral celecoxib 2 h after TKA, 200 mg twice daily, and extended to 5 d postoperatively. All operations were finished by the same surgeon group. Results The postoperative patient-controlled analgesia (PCA) consumption was significantly less in Study group than in Controll group [(43±12) ml vs. (53±12) ml,P<0.05]. The pain scores of postoperative 4, 8, 12 h, 1, 2 d in Study group were 6.1±1.2, 5.0±1.3, 4.3±1.1, 3.4±1.2, significantly less than in Controll group (P<0.05); There were no intergroup significant differences in the pain scores of postoperative 3, 4, 5 d ( P0.05). There were no intergroup significant differences in respect to the side-effect occurrence, operation time and postoperative drainage, postoperative analgesic consumption(P0.05). The time to achieve 90° knee flexion was significantly shorter in Study group than in Controll group [(6.2±1.7) d vs. (8.6±1.8) d, P<0.05]. Conclusions Perioperative administration of the selective Celecoxib holds the effect of preemptive analgesia. Compared with postoperative administration, perioperative administration of celecoxib can alleviate the early postoperative pain score, reduce the consumption of postoperative analgesic, accelerate the recovery of joint motion and thus increase the patient satisfaction.