标题：帕瑞昔布钠在全膝关节置换术后快速康复外科中的镇痛与安全性

      作者：王强 1，黄文 1，周维肖 1，容向宾 2    (广西中医药大学附属瑞康医院麻醉科 1、骨创伤科 2，广西 南宁 530021)

      卷次： 2018年29卷17期

      【摘要】 目的 探讨帕瑞昔布钠在全膝关节置换术后快速康复外科中的镇痛效果、阿片类药物的消耗量和安全性。方法 收集广西中医药大学附属瑞康医院2008年4月至2017年3月因膝关节原发骨性关节炎行初次单侧置换的患者 250例，入院时采用掷骰子方法随机分为安慰剂组(n=129)和帕瑞昔布钠组(n=121)，记录两组患者术后第 2天和第 3天累计疼痛强度评分(SPI-24)，盐酸吗啡消耗量，阿片类药物相关症状发生例数和总的发生率，以及治疗相关不良事件。结果 术后第 2、3天帕瑞昔布钠组患者的 SPI-24评分[(28.9±15.3)分、(25.9±13.6)分)、吗啡累积消耗量[(30.1±17.4) mg、(48.8±25.2) mg]明显低于安慰剂组的评分[(34.2±16.8)分、(29.8±14.7)分]和消耗量[(40.1±21.5) mg、(72.8±37.3) mg]，差异均有统计学意义(P<0.05)；术后第2、3天安慰剂组出现阿片类药物相关症状发生率分别为14.0%和12.4%，高于帕瑞昔布钠组的12.4%和8.3%，但两组比较差异均无统计学意义(P>0.05)；两组患者均未出现治疗相关不良事件。结论 帕瑞昔布钠在全膝关节置换术后的应用具有高效镇痛、节约阿片类药物、安全的特点，有助于术后快速康复。
      【关键词】 帕瑞昔布钠；全膝关节置换术；术后镇痛；安全性
      【中图分类号】 R687.3 【文献标识码】 A 【文章编号】 1003—6350（2018）17—2408—03

Analgesic and safety of parecoxib sodium in rapid rehabilitation surgery after total knee arthroplasty.
WANGQiang 1, HUANG Wen 1, ZHOU Wei-xiao 1, RONG Xiang-bin 2. Department of Anesthesia 1, Department of Orthopedics 2,Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning 530021, Guangxi, CHINA
【Abstract】 Objective To investigate the analgesic, opioids sparing and safety of parecoxib sodium in rapid re-habilitation surgery after total knee arthroplasty. Methods A total of 250 patients with primary unilateral replacementof primary osteoarthritis of the knee, who admitted to Ruikang Hospital Affiliated to Guangxi University of TraditionalChinese Medicine from April 2008 to March 2017, were selected as the research objects. These patients were randomlyassigned to the placebo group (n=129) and the parecoxib sodium group (n=121) according to the dice method on admis-sion. Summed pain intensity over 24 h (SPI-24), morphine hydrochloride consumption, the number of cases related toopioid-related symptoms and the overall incidence and treatment-related adverse events were recorded in the first andsecond days after operation. Results The SPI-24 scores, morphine cumulative consumption of patients in theparecoxib sodium group on the 2nd and 3rd postoperative day were (28.9±15.3) points and (25.9±13.6 ) points, (30.1±17.4) mg and (48.8± 25.2) mg, respectively, which were significantly lower than (34.2±16.8) points and (29.8±14.7) points,(40.1±21.5) mg and (72.8±37.3) mg of the placebo group (P<0.05); the incidence of opioid-related symptoms in the place-bo group on the 2nd and 3rd postoperative days were 14.0% and 12.4% , respectively, which was slightly higher than12.4% and 8.3% of the parecoxib sodium group (P>0.05). There was no treatment-related adverse events in the twogroups. Conclusion The application of parecoxib sodium in total knee arthroplasty has the advantages of high efficien-cy analgesia, opioids sparing and safe, and it is helpful for rapid recovery after operation.
      【Key words】 Parecoxib sodium; Total knee arthroplasty; Postoperative analgesia; Safety·论 著·doi:10.3969/j.issn.1003-6350.2018.17.012基金项目：广西卫生厅课题项目(编号：Z2014555)