中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
10期
1226-1228
,共3页
李雪靖%董江涛%门小茜%杨查响%刘飞飞
李雪靖%董江濤%門小茜%楊查響%劉飛飛
리설정%동강도%문소천%양사향%류비비
环加氧酶抑制药%注射,肌肉内%镇痛%关节成形术,置换,膝%疼痛,手术后
環加氧酶抑製藥%註射,肌肉內%鎮痛%關節成形術,置換,膝%疼痛,手術後
배가양매억제약%주사,기육내%진통%관절성형술,치환,슬%동통,수술후
Cyclooxygenase inhibitors%Injections,intramuscular%Analgesia%Arthroplasty,replacement,knee%Pain,postoperative
目的 评价肌肉注射帕瑞昔布钠用于全膝关节置换术病人术后镇痛的效果.方法 拟行单侧全膝关节置换术的的骨关节炎病人54例,性别不限,年龄65 ～ 75岁,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将病人随机分成2组(n=27)∶曲马多组(T组)和帕瑞昔布钠组(P组).2组均采用全凭静脉麻醉.P组分别于术前12 h及术后12、24、36、48、60、72 h时肌肉注射帕瑞昔布钠40 mg,T组在相应时间点给予曲马多100 mg.当术后镇痛无效(VAS评分＞3分)时肌肉注射哌替啶50 mg进行补救镇痛,分别记录静态和动态时镇痛无效情况.记录术后膝关节活动度达到90°的时间和心血管事件发生情况；术后7、14 d行双下肢静脉多普勒超声检查,记录下肢静脉血栓形成的发生情况.结果 与T组比较,P组静态和动态时镇痛无效率降低,术后膝关节活动度达到90°时间缩短,深静脉血栓形成发生率降低(P＜ 0.05或0.01),心血管事件发生率和肌间静脉血栓形成发生率差异无统计学意义(P＞0.05).结论 术前12 h及术后间断肌肉注射帕瑞昔布钠40 mg可明显缓解全膝关节置换术病人术后疼痛,有助于术后关节功能的康复,且可降低深静脉血栓形成的发生.
目的 評價肌肉註射帕瑞昔佈鈉用于全膝關節置換術病人術後鎮痛的效果.方法 擬行單側全膝關節置換術的的骨關節炎病人54例,性彆不限,年齡65 ～ 75歲,ASA分級Ⅰ～Ⅲ級,採用隨機數字錶法,將病人隨機分成2組(n=27)∶麯馬多組(T組)和帕瑞昔佈鈉組(P組).2組均採用全憑靜脈痳醉.P組分彆于術前12 h及術後12、24、36、48、60、72 h時肌肉註射帕瑞昔佈鈉40 mg,T組在相應時間點給予麯馬多100 mg.噹術後鎮痛無效(VAS評分＞3分)時肌肉註射哌替啶50 mg進行補救鎮痛,分彆記錄靜態和動態時鎮痛無效情況.記錄術後膝關節活動度達到90°的時間和心血管事件髮生情況；術後7、14 d行雙下肢靜脈多普勒超聲檢查,記錄下肢靜脈血栓形成的髮生情況.結果 與T組比較,P組靜態和動態時鎮痛無效率降低,術後膝關節活動度達到90°時間縮短,深靜脈血栓形成髮生率降低(P＜ 0.05或0.01),心血管事件髮生率和肌間靜脈血栓形成髮生率差異無統計學意義(P＞0.05).結論 術前12 h及術後間斷肌肉註射帕瑞昔佈鈉40 mg可明顯緩解全膝關節置換術病人術後疼痛,有助于術後關節功能的康複,且可降低深靜脈血栓形成的髮生.
목적 평개기육주사파서석포납용우전슬관절치환술병인술후진통적효과.방법 의행단측전슬관절치환술적적골관절염병인54례,성별불한,년령65 ～ 75세,ASA분급Ⅰ～Ⅲ급,채용수궤수자표법,장병인수궤분성2조(n=27)∶곡마다조(T조)화파서석포납조(P조).2조균채용전빙정맥마취.P조분별우술전12 h급술후12、24、36、48、60、72 h시기육주사파서석포납40 mg,T조재상응시간점급여곡마다100 mg.당술후진통무효(VAS평분＞3분)시기육주사고체정50 mg진행보구진통,분별기록정태화동태시진통무효정황.기록술후슬관절활동도체도90°적시간화심혈관사건발생정황；술후7、14 d행쌍하지정맥다보륵초성검사,기록하지정맥혈전형성적발생정황.결과 여T조비교,P조정태화동태시진통무효솔강저,술후슬관절활동도체도90°시간축단,심정맥혈전형성발생솔강저(P＜ 0.05혹0.01),심혈관사건발생솔화기간정맥혈전형성발생솔차이무통계학의의(P＞0.05).결론 술전12 h급술후간단기육주사파서석포납40 mg가명현완해전슬관절치환술병인술후동통,유조우술후관절공능적강복,차가강저심정맥혈전형성적발생.
Objective To evaluate the efficacy of intramuscular parecoxib for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Fifty-four ASA Ⅰ-Ⅲ patients,aged 65-75 yr,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =27 each)∶ tramadol group (group T) and parecoxib group (group P).Total intravenous anesthesia was used in both groups.Group P received intramuscular injection of parecoxib 40 mg at 12 h before operation and 12,24,36,48,60 and 72 h after operation,and group T received tramadol 100 mg at the same time points.When VAS score was more than 3 after operation,intramuscular parecoxib 50 mg was given as rescue analgesic.The ineffective analgesia at rest and during activity was recorded.The time for knee range of motion to reach 90° and cardiovascular events were recorded.The ultrasonic inspection was performed on veins of the bilateral lower extremities at 7 and 14 days after operation for detection of vein thrombosis.Results Compared with T group,the rate of ineffective analgesia at rest and during activity was significantly decreased,the time for knee range of motion to reach 90° was shortened,and the incidence of deep vein thrombosis was significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidences of cardiovascular events and intramuscular venous thrombosis in group P (P ＞ 0.05).Conclusion Parecoxib 40 mg injected intramuscularly before and after operation can significantly relieve postoperative pain,is helpful for the hip function rehabilitation and can reduce the occurrence of deep vein thrombosis in patients undergoing total knee arthroplasty.
