CAJ | 학술논문

背景：髋膝关节置换是临床上常见的手术，相对比较复杂，风险也相对比较高，使得患者置换后镇痛效果并不理想。围置换期疼痛处理一直是临床所关注的问题，寻找安全、有效的镇痛方法，已经成为关节外科医生的重要任务之一。目的：探讨塞来昔布在髋膝关节置换后多模式镇痛中的效果。方法：从重庆市东南医院2012年9月至2013年9月收治的髋膝关节置换患者中选择80例进行分析，按随机数字表法分为两组，对照组置换后不使用塞来昔布镇痛，试验组置换后采用塞来昔布镇痛。观察两组患者置换后1-5 d的疼痛情况，记录止痛泵撤除时药物所剩剂量及阿片类止痛药物使用情况，统计患者使用镇痛药物后的药物不良反应。结果与结论：在镇痛疗效方面，试验组镇痛方案效果显著，明显优于对照组(95%，85%，P <0.05)；试验组95%对镇痛满意，显著高于对照组65%(P <0.05)。两组患者置换当天、置换后第4，5天手术切口疼痛的目测类比评分差异无显著性意义(P >0.05)；试验组置换后第1，2，3天手术切口疼痛的目测类比评分均显著低于对照组(P <0.05)。试验组置换后止痛药物剩余量显著多于对照组(P <0.05)，阿片类药物使用次数显著低于对照组(P <0.05)。试验组并发症发生率为8%，显著低于对照组18%(P <0.05)。提示髋膝关节置换后多模式镇痛下使用塞来昔布镇痛效果理想，能够减少止痛药物使用剂量，药物不良反应少。
배경：관슬관절치환시림상상상견적수술，상대비교복잡，풍험야상대비교고，사득환자치환후진통효과병불이상。위치환기동통처리일직시림상소관주적문제，심조안전、유효적진통방법，이경성위관절외과의생적중요임무지일。목적：탐토새래석포재관슬관절치환후다모식진통중적효과。방법：종중경시동남의원2012년9월지2013년9월수치적관슬관절치환환자중선택80례진행분석，안수궤수자표법분위량조，대조조치환후불사용새래석포진통，시험조치환후채용새래석포진통。관찰량조환자치환후1-5 d적동통정황，기록지통빙철제시약물소잉제량급아편류지통약물사용정황，통계환자사용진통약물후적약물불량반응。결과여결론：재진통료효방면，시험조진통방안효과현저，명현우우대조조(95%，85%，P <0.05)；시험조95%대진통만의，현저고우대조조65%(P <0.05)。량조환자치환당천、치환후제4，5천수술절구동통적목측류비평분차이무현저성의의(P >0.05)；시험조치환후제1，2，3천수술절구동통적목측류비평분균현저저우대조조(P <0.05)。시험조치환후지통약물잉여량현저다우대조조(P <0.05)，아편류약물사용차수현저저우대조조(P <0.05)。시험조병발증발생솔위8%，현저저우대조조18%(P <0.05)。제시관슬관절치환후다모식진통하사용새래석포진통효과이상，능구감소지통약물사용제량，약물불량반응소。
BACKGROUND:Hip and knee replacement is a common surgery in the clinic; the procedure is relatively complex; and the risk of surgery is relatively high, so that postoperative analgesia is not satisfactory. Perioperative pain management has been a clinical concern. To find safe and effective analgesia has become one of the important tasks of joint surgeons. OBJECTIVE:To investigate the effect of celecoxib on multi-mode analgesia after hip and knee replacement. METHODS: A total of 80 cases undergoing hip and knee replacement in the Chongqing Dongnan Hospital from September 2012 to September 2013 were enroled in this study. These patients were randomly divided into two groups. In the control group, celecoxib was not used for analgesia after replacement. In the experimental group, celecoxib was used after replacement. The pain was observed at 1-5 days after surgery in the two groups. When the analgesic pump was removed, the drug dosage and opioid analgesics use were recorded. Side effects of drug use were also recorded. RESULTS AND CONCLUSION:In terms of analgesic efficacy, the analgesic effect was better in the experimental group than in the control group (95%, 85%, P < 0.05). 95% patients in the experimental group were satisfied with the analgesia, which was significantly higher than in the control group (65%;P< 0.05). No significant difference in pain visual analogue scale score was detected between the two groups immediately, 4 and 5 days after surgery (P > 0.05). Pain visual analogue scale score was significantly lower in the experimental group than in the control group at 1, 2 and 3 days post surgery (P< 0.05). The drug dosage was significantly more in the experimental group than in the control group after surgery (P < 0.05). The frequency of opioid use in the experimental group was significantly lower than in the control group (P < 0.05). The complication rate was significantly lower in the experimental group (8%) than in the control group (18%) (P < 0.05). These findings demonstrate that the analgesic effect of celecoxib was ideal after hip and knee replacement using multi-mode analgesia, which can reduce the dose of analgesic drugs and have smal adverse reaction.