不同时点静注帕瑞昔布钠联合硬膜外镇痛对全膝置换术后疼痛的影响

目的观察不同时点静注帕瑞昔布钠联合硬膜外镇痛对全膝置换术后疼痛及血流动力学的影响。方法将30例ASAⅡ^Ⅲ级择期全膝关节置换术后患者随机分为A、B两组,每组各15例。A组于切皮前静注帕瑞昔布钠40 mg,B组于手术结束前静注帕瑞昔布钠40 mg,两组均行硬膜外镇痛(PCA)。观察并记录两组术后2、4、6、12和24 h静息和运动的疼痛强度(VAS)、收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO2)、术后4、6、12 h时段PCA总按压次数和有效按压次数、综合满意度以及不良反应。结果 A组术后4、6 h静息和运动VAS评分均低于B组(p<0.05),术后2、4、6、12 h A组SBP、DBP、HR均低于B组(p<0.05),术后4、6、12 h PCA有效按压次数和总按压次数A组均低于B组(p<0.01),A组非常满意高于B组(p<0.05)。结论术前静注帕瑞昔布钠联合硬膜外镇痛可以有效地减轻全膝置换术后疼痛以及维持血流动力学的稳定。

THE EFFECTS OF INTRAVENOUS INJECTION OF PARECOXIB AT DIFFERENT TIME POINTS AND EPIDURAL ANALGESIA ON POSTOPERATIVE PAIN AFTER TOTAL KNEE ARTHROPLASTY

Objective To observe the effect of intravenous injection parecoxib at different time points and postoperative epidural analgesia on postoperative pain and hemodynamics after total knee arthroplasty （TKA）. Methods Thirty ASA Ⅱ-Ⅲ elderly patients undergoing selective TKA were randomized into two groups, each group included 15 patients. Group A：parecoxib 40 mg were intravenous given 10 min before skin incision. Group B：parecoxib 40 mg were intravenous 10 min before the end of operation. Two groups received postoperative epidural analgesia （PCA）. The efficacy evaluation included visual analog scale （VAS） of pain at rest and after movement, SBP, DBP, HR, SPO2 in 2,4,6,12 and 24 h and adverse effect were recorded after surgery. The total number of attemps and the number of successfully delivered doses in 4,6 and 12 h and side effects and comprehensive satisfaction of anaesthesia were recorded. Results The VAS of pain at rest and movement in Group A were lower than Group B in 4,6 h（p 〈 0. 05）. SBP,DBP,HR in Group A were lower than Group B in 2,4,6 and 12 h（p 〈0. 05）. The total number of attemps and the number of successfully delivered doses in Group A were lower than Group B in 4,6 and 12 h（p 〈 0.01 ）. The degree of satisfaction in Group A were higher than Group B （p 〈 0. 05）. Conclusion Before surgery intravenous injection parecoxib can efficiently reduce postoperative pain and stabilize hemodynamic effects after total knee arthroplasty.