塞来昔布联合帕瑞昔布钠超前镇痛方案对胸腰椎后路手术术后镇痛的效果观察

Clinical outcome of preoperative analgesia by using celecoxib and parecoxib-sodium for postoperative pain management after posterior thoracic and lumbar surgery

中文关键词:  胸腰椎后路手术；超前镇痛  帕瑞昔布钠；塞来昔布；术后疼痛

英文关键词:Posterior thoracic and lumbar surgery  Preoperative analgesia  Parecoxib-sodium  Celecoxib  Postoperative pain

中文摘要:

  【摘要】 目的：观察塞来昔布联合帕瑞昔布钠超前镇痛方案治疗胸腰椎后路手术后早期疼痛的效果。方法：2011年5月~2012年4月将拟接受手术治疗且无消化性溃疡、冠心病病史的138例胸腰椎患者（胸腰椎骨折57例，腰椎间盘突出症49例，腰椎管狭窄症21例及退变性腰椎滑脱11例）随机分为3组，每组46例，A组为术后塞来昔布镇痛方案组，B组为术后帕瑞昔布钠镇痛方案组，C组为塞来昔布联合帕瑞昔布钠的围手术期超前镇痛方案组。3组患者病种分布情况、性别、年龄、体重及术前疼痛视觉模拟评分（visual analogue scale,VAS）均无统计学差异（P＞0.05）。所有患者均接受全麻下胸腰椎后路减压、椎间植骨融合或后外侧植骨融合、椎弓根螺钉内固定术，并分别按照各自组内用药方案予以镇痛。记录每例患者术后6、12、24、48、72h的疼痛评分、术后追加盐酸曲马多及盐酸哌替啶用量和发生不良反应的例数，并进行统计学分析。结果：C组术后各时间点镇痛效果显著优于A组和B组（P＜0.05）；术后追加镇痛药物用量C组显著小于A组和B组（P＜0.05）；发生不良反应例数C组显著少于A组（P＜0.05），C组发生不良反应例数与B组比较无统计学差异（P＞0.05）。结论：塞来昔布联合帕瑞昔布钠超前镇痛方案对胸腰椎后路手术术后早期疼痛效果良好，其镇痛作用强于单纯应用塞来昔布或帕瑞昔布钠，并可显著减少追加镇痛药物的用量，不良反应发生率较低。

英文摘要:

  【Abstract】　Objectives: To observe the clinical outcome of preoperative analgesia by using parecoxib-sodium and celecoxib for postoperative pain management after posterior thoracic and lumbar surgery. Methods: From May 2011 to April 2012, 138 patients undergoing posterior thoracic and lumbar surgery were randomly divided into three groups: celecoxib group(group A, n=46), parecoxib-sodium group(group B, n=46) and preoperative analgesia group in which combined use of parecoxib-sodium and celecoxib was performed(group C, n=46). All of them denied the histories such as peptic ulcer and coronary disease. The pathogenesis included thoracolumbar fractures and degenerative disorders such as lumbar disc herniation and spinal canal stenosis. There was no significant difference with respect to patients′ preoperative general conditions and pain scores(by means of VAS) among three groups（P＞0.05）. Posterior decompression, PLIF or PLF was performed in all patients. The pain scores of 6h, 12h, 24h, 48h, 72h after operation and the dose of tramadol hydrochloride and pethidine hydrochloride used postoperatively and the side effect was recorded respectively. Results: Group C had significantly better analgesic effect than group B and group A（P＜0.05）. Group C had lower average dose of tramadol hydrochloride and pethidine hydrochloride than group A and B（P＜0.05）. Compared with group A, group C had less side effects recorded, which showed significant difference（P＜0.05）. Compared with group B, although group C had less side effects, the difference was not significant（P＞0.05）. Conclusions: Preoperative analgesia by using celecoxib and parecoxib-sodium is effective for postoperative pain management after posterior thoracic and lumbar surgery, and their combined use is superior than separate use, which can lower the dose as well as the rate of side effect.