CAJ | 학술논문

目的：评价帕瑞昔布钠对全膝关节置换术后连续股神经阻滞的镇痛效果及对早期膝关节功能恢复的影响。方法2012年5～12月择期行全膝关节置换术患者100例，于腰麻硬膜外联合麻醉前行连续股神经阻滞并用于术后镇痛。患者以随机、双盲形式分为2组：连续股神经镇痛组（ C组）和帕瑞昔布钠联合连续股神经镇痛组（ P组），P组于切皮前30 min和术后12、24、36和48 h静脉注射帕瑞昔布钠40 mg，C组给予等量生理盐水。术后对2组静息和被动运动时膝关节前后部疼痛视觉模拟评分（ visual analogue scale ，VAS）、镇痛泵按压次数、主动直腿抬高时间、被动屈膝90°时间、术前及术后72 h美国特种外科医院膝关节评分（ Hospital for Special Surgery Knee Score ，HSS）进行评估。结果静息时膝关节前部VAS评分各时点2组相似（P＞0．05），后部VAS评分在术后8、12、24、48 h时P组比C组降低（P＜0．05）；膝关节被动运动时前部VAS评分在24、48 h时P组比C组降低（P＜0．05），后部VAS评分在24 h时P组比C组降低（P＜0．05）；镇痛泵按压次数在术后4～8 h及8～12 h时间段P组比C组减少（P＜0．05）；2组术前、术后72 h HSS评分差异无显著性（P＞0．05）；主动直腿抬高时间、被动屈膝90°时间P组比C组缩短（P＜0．05）。结论帕瑞昔布钠对全膝关节置换术后连续股神经阻滞的患者在一定程度上缓解疼痛，缩短主动直腿抬高时间、被动屈膝90°时间从而部分改善早期膝关节功能，具有较好的促进恢复作用。
목적：평개파서석포납대전슬관절치환술후련속고신경조체적진통효과급대조기슬관절공능회복적영향。방법2012년5～12월택기행전슬관절치환술환자100례，우요마경막외연합마취전행련속고신경조체병용우술후진통。환자이수궤、쌍맹형식분위2조：련속고신경진통조（ C조）화파서석포납연합련속고신경진통조（ P조），P조우절피전30 min화술후12、24、36화48 h정맥주사파서석포납40 mg，C조급여등량생리염수。술후대2조정식화피동운동시슬관절전후부동통시각모의평분（ visual analogue scale ，VAS）、진통빙안압차수、주동직퇴태고시간、피동굴슬90°시간、술전급술후72 h미국특충외과의원슬관절평분（ Hospital for Special Surgery Knee Score ，HSS）진행평고。결과정식시슬관절전부VAS평분각시점2조상사（P＞0．05），후부VAS평분재술후8、12、24、48 h시P조비C조강저（P＜0．05）；슬관절피동운동시전부VAS평분재24、48 h시P조비C조강저（P＜0．05），후부VAS평분재24 h시P조비C조강저（P＜0．05）；진통빙안압차수재술후4～8 h급8～12 h시간단P조비C조감소（P＜0．05）；2조술전、술후72 h HSS평분차이무현저성（P＞0．05）；주동직퇴태고시간、피동굴슬90°시간P조비C조축단（P＜0．05）。결론파서석포납대전슬관절치환술후련속고신경조체적환자재일정정도상완해동통，축단주동직퇴태고시간、피동굴슬90°시간종이부분개선조기슬관절공능，구유교호적촉진회복작용。
Objective To investigate the effects of parecoxib sodium on continuous femoral nerve block ( CFNB) analgesia and early rehabilitation training after total knee arthroplasty ( TKA) . Methods A total of 100 patients undergoing elective TKA from May 2012 to December 2012 were enrolled in this randomized , double blind , placebo controlled study .All patients received CFNB before combined spinal epidural anesthesia .They were randomly divided into 2 groups (n=50 each):CFNB (group C) and parecoxib sodium with CFNB (group P).Group P received parecoxib sodium 40 mg before incision and 12, 24, 36, 48 h after operation, while the equal volume of normal saline was used instead of parecoxib sodium in group C .Postoperative pain during rest and passive exercises including front and rear portions of knees using visual analogue scale ( VAS ) , the number of attempt PCA ( patient controlled analgesia), the time to perform an active straight leg raise , the time to reach 90 degree knee flexion passively , and preoperative and postoperative HSS scores (Hospital for Special Surgery Knee Score ) were evaluated. Results All patients in both groups had similar reduced rest pain in the front of knees , but VAS scores at the back of knees were significantly lower in group P at 8, 12, 24 and 48 h postoperatively when compared with group C (P<0.05).During passive exercises, VAS scores in the front of knees at 24, 48 h and in the back of knees at 24 h postoperatively were reduced significantly in group P when compared with group C (P<0.05).The number of attempt PCA in group P was less than that in group C during 4-8 h and 8-12 h postoperatively(P<0.05).There was no significant difference in preoperative and postoperative HSS scores (P>0.05) between the two groups.Compared with group C, the time to perform an active straight leg raise and the time to reach 90 degree knee flexion passively were significantly decreased in group P ( P<0.05). Conclusion Parecoxib sodium can to some extent improve CFNB analgesia , and shorten the time to perform active straight leg raise and to reach 90 degree knee flexion , consequently improving early-stage knee joint function and resulting in better recovery .