CAJ | 학술논문

目的探讨塞来昔布及帕瑞昔布联合应用进行超前镇痛对下肢骨折患者术后疼痛及应激反应的影响,以提供骨折术后的疼痛护理方法.方法将82例下肢骨折患者随机分为实验组和对照组各41例,实验组接受超前镇痛治疗,对照组接受常规镇痛治疗,比较两组患者术后4,8,12,24,48 h视觉模拟评分(VAS),两组患者术前、术后0,4,12,24h血管紧张素Ⅱ、胰高血糖素和血皮质醇水平及两组不良反应发生率.结果实验组术后4,8,12 h VAS评分分别为(3.54±0.68),(4.08±0.97),(3.41±0.59)分,分别低于对照组的(4.63±0.92),(5.38±1.17),(4.48 ±0.76)分,差异均有统计学意义(t分别为4.274 5,4.8754,4.453 7；P＜0.05),而术后24,48 h两组VAS评分比较,差异无统计学意义(P＞0.05)；术后0,4,12h血管紧张素Ⅱ、胰高血糖素和血皮质醇水平实验组均低于对照组,差异均有统计学意义(P＜0.05),而术前及术后24h两组比较,差异均无统计学意义(P＞0.05)；对照组不良反应发生率为31.7％,高于实验组的7.3％,差异有统计学意义(x2=7.77,P＜0.01)；实验组患者共13例加用曲马多,对照组共32例加用曲马多,实验组术后曲马多的使用次数明显少于对照组,差异有统计学意义(x2=10.05,P＜0.01).结论塞来昔布联合帕瑞昔布实施超前镇痛能够减轻下肢骨折患者术后疼痛,减轻患者术后应激反应,减少不良反应发生.
목적 탐토새래석포급파서석포연합응용진행초전진통대하지골절환자술후동통급응격반응적영향,이제공골절술후적동통호리방법.방법 장82례하지골절환자수궤분위실험조화대조조각41례,실험조접수초전진통치료,대조조접수상규진통치료,비교량조환자술후4,8,12,24,48 h시각모의평분(VAS),량조환자술전、술후0,4,12,24h혈관긴장소Ⅱ、이고혈당소화혈피질순수평급량조불량반응발생솔.결과 실험조술후4,8,12 h VAS평분분별위(3.54±0.68),(4.08±0.97),(3.41±0.59)분,분별저우대조조적(4.63±0.92),(5.38±1.17),(4.48 ±0.76)분,차이균유통계학의의(t분별위4.274 5,4.8754,4.453 7；P＜0.05),이술후24,48 h량조VAS평분비교,차이무통계학의의(P＞0.05)；술후0,4,12h혈관긴장소Ⅱ、이고혈당소화혈피질순수평실험조균저우대조조,차이균유통계학의의(P＜0.05),이술전급술후24h량조비교,차이균무통계학의의(P＞0.05)；대조조불량반응발생솔위31.7％,고우실험조적7.3％,차이유통계학의의(x2=7.77,P＜0.01)；실험조환자공13례가용곡마다,대조조공32례가용곡마다,실험조술후곡마다적사용차수명현소우대조조,차이유통계학의의(x2=10.05,P＜0.01).결론 새래석포연합파서석포실시초전진통능구감경하지골절환자술후동통,감경환자술후응격반응,감소불량반응발생.
Objective To study the effect of preemptive analgesia with celecoxib and parecoxib on the postoperative pain and stress responses of patients with leg fracture.Methods Eighty-two patients with leg fracture were randomly divided into experiment group( n =41 ) which received preemptive analgesia,and control group( n =41 ) which received routine analgesia.The visual analogue scale (VAS) was used to measured patients'pain at 4,8,12,24,48 h after operation.Levels of blood angiotensin-Ⅱ,cortisol and glucagon were assayed at various times as follows:pre-operation,end of surgery,postoperative 0,4,12,24 h,and adverse effects rate was observed in two groups.Results The postoperative 4,8,12,24 h score of experiment group were ( 3.54 ± 0.68),(4.08 ±0.97),(3.41 ± 0.59),respectively,lower than that of control group that were (4.63 ± 0.92),(5.38 ± 1.17),(4.48 ± 0.76 ),and the differences were statistically significant ( t =4.274 5,4.875 4,4.453 7,respectively ; P ＜0.05 ).While there was no significant difference detected in the VAS score of 24,48h between two groups (P ＞0.05).Levels of blood angiotensin- Ⅱ,cortisol and glucagon of patients' in 0,4,12 h of experiment group were significantly lower than that of the control group ( P ＜ 0.05 ),while no significant difference was found in the preoperation and post-operation 24 h between two groups( P ＞ 0.05 ).Adverse effects rate of experiment group was 7.3％ significantly lower than 31.7％ that of control group,the difference was statistically significant (x2 =7.77,P ＜0.01 ).There were 13 cases received the medicine of tramadol in experiment group and 32 cases in control group,and the difference was statistically significant (x2 =10.05,P ＜0.0 1 ).Conclusions Preemptive analgesia with celecoxib and parecoxib could decrease the postoperative pain of patients with leg fracture and reduce the adverse effects rate significantly and the stress reaction in postoperative period.