CAJ | 학술논문

背景：超前镇痛的有效性目前存在争议，既往研究中关于置换前因素对外周及中枢敏感化作用的重视程度不够。目测类比评分法在某些时候不能有效的反映患者的疼痛情况，其客观性和重复性不佳。 　　目的：观察塞来昔布对膝关节表面置换患者置换前预防性镇痛的有效性。 　　方法：选取因膝关节病行膝关节表面置换的患者为评估对象，经匹兹堡睡眠质量指数、抑郁自评量表及焦虑自评量表评分后筛选出患者30例，按随机数表法等分为塞来昔布组和维生素 C 组。两组患者入院后第2-4天分别口服塞来昔布与维生素C，并分别于服药前1 d晚及服药后第3天晚用目测类比评分法评定患者轻重侧静息及活动时的疼痛程度，再用痛阈测量仪测量患者的电痛阈及电耐痛阈值，测量过程遵循随机双盲对照原则。 　　结果与结论：塞来昔布组患者服用塞来昔布3d后双膝静息及运动状态下目测类比评分变化差异无显著性意义(P>0.05)，双侧下肢的电痛阈较服药前提高(P<0.05)，重侧电痛阈值(目测类比评分较轻侧高)服药前、后变化较轻侧明显(P <0.05)，双侧下肢电耐痛阈用药前后的目测类比评分变化差异无显著性意义(P >0.05)；塞来昔布组患者服药前后双膝轻重侧的目测类比评分变化差值与对应侧的电痛阈及电耐痛阈的变化差值无显著相关性(P>0.05)；维生素 C组患者服药前后双膝的目测类比评分、双侧下肢电痛阈及电耐痛阈变化均差异无显著性意义(P>0.05)。结果证实，塞来昔布可提高膝关节病患者行全膝关节表面置换置换前的电痛阈，重侧更为敏感，在全膝关节表面置换前可发挥预防性镇痛的作用。相对于目测类比评分，痛阈的变化或能更敏感地反映膝关节置换患者用药前后的疼痛变化，疼痛水平的变化与疼痛敏感度的变化之间尚无相关性。揹景：超前鎮痛的有效性目前存在爭議，既往研究中關于置換前因素對外週及中樞敏感化作用的重視程度不夠。目測類比評分法在某些時候不能有效的反映患者的疼痛情況，其客觀性和重複性不佳。 　　目的：觀察塞來昔佈對膝關節錶麵置換患者置換前預防性鎮痛的有效性。 　　方法：選取因膝關節病行膝關節錶麵置換的患者為評估對象，經匹玆堡睡眠質量指數、抑鬱自評量錶及焦慮自評量錶評分後篩選齣患者30例，按隨機數錶法等分為塞來昔佈組和維生素 C 組。兩組患者入院後第2-4天分彆口服塞來昔佈與維生素C，併分彆于服藥前1 d晚及服藥後第3天晚用目測類比評分法評定患者輕重側靜息及活動時的疼痛程度，再用痛閾測量儀測量患者的電痛閾及電耐痛閾值，測量過程遵循隨機雙盲對照原則。 　　結果與結論：塞來昔佈組患者服用塞來昔佈3d後雙膝靜息及運動狀態下目測類比評分變化差異無顯著性意義(P>0.05)，雙側下肢的電痛閾較服藥前提高(P<0.05)，重側電痛閾值(目測類比評分較輕側高)服藥前、後變化較輕側明顯(P <0.05)，雙側下肢電耐痛閾用藥前後的目測類比評分變化差異無顯著性意義(P >0.05)；塞來昔佈組患者服藥前後雙膝輕重側的目測類比評分變化差值與對應側的電痛閾及電耐痛閾的變化差值無顯著相關性(P>0.05)；維生素 C組患者服藥前後雙膝的目測類比評分、雙側下肢電痛閾及電耐痛閾變化均差異無顯著性意義(P>0.05)。結果證實，塞來昔佈可提高膝關節病患者行全膝關節錶麵置換置換前的電痛閾，重側更為敏感，在全膝關節錶麵置換前可髮揮預防性鎮痛的作用。相對于目測類比評分，痛閾的變化或能更敏感地反映膝關節置換患者用藥前後的疼痛變化，疼痛水平的變化與疼痛敏感度的變化之間尚無相關性。
배경：초전진통적유효성목전존재쟁의，기왕연구중관우치환전인소대외주급중추민감화작용적중시정도불구。목측류비평분법재모사시후불능유효적반영환자적동통정황，기객관성화중복성불가。 　　목적：관찰새래석포대슬관절표면치환환자치환전예방성진통적유효성。 　　방법：선취인슬관절병행슬관절표면치환적환자위평고대상，경필자보수면질량지수、억욱자평량표급초필자평량표평분후사선출환자30례，안수궤수표법등분위새래석포조화유생소 C 조。량조환자입원후제2-4천분별구복새래석포여유생소C，병분별우복약전1 d만급복약후제3천만용목측류비평분법평정환자경중측정식급활동시적동통정도，재용통역측량의측량환자적전통역급전내통역치，측량과정준순수궤쌍맹대조원칙。 　　결과여결론：새래석포조환자복용새래석포3d후쌍슬정식급운동상태하목측류비평분변화차이무현저성의의(P>0.05)，쌍측하지적전통역교복약전제고(P<0.05)，중측전통역치(목측류비평분교경측고)복약전、후변화교경측명현(P <0.05)，쌍측하지전내통역용약전후적목측류비평분변화차이무현저성의의(P >0.05)；새래석포조환자복약전후쌍슬경중측적목측류비평분변화차치여대응측적전통역급전내통역적변화차치무현저상관성(P>0.05)；유생소 C조환자복약전후쌍슬적목측류비평분、쌍측하지전통역급전내통역변화균차이무현저성의의(P>0.05)。결과증실，새래석포가제고슬관절병환자행전슬관절표면치환치환전적전통역，중측경위민감，재전슬관절표면치환전가발휘예방성진통적작용。상대우목측류비평분，통역적변화혹능경민감지반영슬관절치환환자용약전후적동통변화，동통수평적변화여동통민감도적변화지간상무상관성。
BACKGROUND:The preemptive analgesia is stil a controversial issue. Existing studies have not paid much attention to effects of preoperative factors on the hypersensitivity of peripheral and central mechanisms. Visual analog scale scores cannot subjectively and repeatedly reveal patient’s pain. OBJECTIVE:To investigate the validity of the preventive analgesia effect of Celebrex in patients with total knee arthroplasty. METHODS:Patients with osteoarthritis of the knee who received total knee arthroplasty were accessed by Pittsburgh sleep quality index, self-rating depression scale and self-rating anxiety scale. In al , thirty patients were enrol ed in the study. They were randomized into Celebrex group and vitamin C group, and each group had 15 patients. The patients in the Celebrex group and vitamin C group took 200 mg Celebrex and vitamin C, respectively, twice a day from day 2 to day 4. Both of their knees were evaluated by resting visual analogue scale and moving visual analogue scale in the evening of day 1 before treatment and day 3 after treatment. Meanwhile, the pain threshold and pain tolerance were accessed by a pain-threshold machine. RESULTS AND CONCLUSION:No statistical significance of the changes of resting and moving visual analogue scale scores was found in both knees in the Celebrex group (P>0.05). The pain threshold of both knees were significantly increased (P<0.05), and the severe knee, which had less visual analogue scale scores than the minor one, turned out to increase more obviously than the minor knee (P>0.05). There were no significant changes in the pain tolerance in both knees (P>0.05). The changing values of resting or moving visual analogue scale were not significantly correlated with the pain threshold and pain tolerance (P>0.05). There were no significant changes in visual analogue scale scores, pain threshold and pain tolerance in both knees of the vitamin C group (P>0.05). Celebrex could increase the pain threshold of patients receiving total knee arthroplasty, especial y the severe knee, which indicates that the Celebrex is good for the preventive analgesia. Comparatively speaking, the pain threshold might be more sensitive than visual analogue scale in revealing the change of pain after analgesia. There is no significant correlation between visual analogue scale score and the hypersensitivity of pain.