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帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的临床观察
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| 篇名： | 帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的临床观察 |
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| 摘要： | 目的：观察帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的效果及对机体免疫功能的影响。方法：选取2014年1月－2016年6月西宁市第三人民医院需行单侧髋关节置换术的患者86例，按随机数字表法分为观察组和对照组，各43例。两组患者均于腰硬联合麻醉下行单侧髋关节置换术，观察组患者于手术结束前30 min静脉给予注射用帕瑞昔布钠40 mg，对照组患者静脉注射等量生理盐水；两组患者均于术后衔接硬膜外镇痛泵（盐酸罗哌卡因注射液150 mg+盐酸昂丹司琼注射液16 mg+地佐辛注射液10 mg，加生理盐水至100 mL），滴注速度为2 mL/h，自控泵注15 min。比较两组患者不同时间点的血流动力学指标、镇痛效果、T淋巴细胞亚群和自然杀伤（NK）细胞水平，以及术后不良反应发生情况。结果：观察组有2例患者脱落，对照组有1例患者脱落。术前，两组患者平均动脉压（MAP）和心率（HR）比较，差异均无统计学意义（P＞0.05）；术后12、24 h时，对照组患者MAP和HR均较术前显著升高，且显著高于观察组，差异均有统计学意义（P＜0.05）；观察组患者各时间点MAP和HR与术前比较，以及两组患者手术结束即刻、术后48 h时的MAP和HR比较，差异均无统计学意义（P＞0.05）。手术结束即刻，两组患者VAS评分比较，差异均无统计学意义（P＞0.05）；术后6、12、24、48 h时，观察组患者VAS评分显著低于对照组，差异均有统计学意义（P＜0.05）。术前，两组患者CD3+、CD4+、CD8+、CD4+/CD8+和NK细胞水平比较，差异均无统计学意义（P＞0.05）；两组患者手术结束即刻的CD3+、CD4+和NK细胞水平，两组患者术后12、24 h时的CD3+、CD4+、CD4+/CD8+和NK细胞水平，以及对照组患者术后48 h时的CD3+、CD4+水平均较术前有显著变化，且观察组患者术后12、24 h时的CD3+、CD4+、CD4+/CD8+和NK细胞水平显著高于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：帕瑞昔布超前镇痛联合术后硬膜外镇痛对髋关节置换术患者镇痛效果好，使患者血流动力学稳定，且该方案对机体免疫功能具有一定的保护作用，安全性较好。 |
| ABSTRACT： | OBJECTIVE： To observe the effects of parecoxib preemptive analgesia combined with postoperative epidural analgesia on hip replacement and immune function. METHODS： Totally 86 patients undergoing unilateral hip replacement selected from Xining Third People’s Hospital during Jan. 2014- Jun. 2016 were divided into observation group and control group according to random number table， with 43 cases in each group. Two groups underwent unilateral hip replacement under spinal epidural anesthesia. Observation group was given Parecoxib sodium for injection 40 mg intravenously 30 min before the end of surgery. Control group was given constant volume of normal saline intravenously. Both groups were given epidural analgesia pump （Ropivacaine hydrochloride injection 150 mg+ Ondansetron hydrochloride injection 16 mg+Dezocine injection 10 mg， added into normal saline to 100 mL） after surgery with dripping speed of 2 mL/h and patient-controlled time of 15 min. The hemodynamic indexes， analgesic effect， T lymphocyte subsets and NK cells levels were compared between 2 groups at different time points as well as the occurrence of ADR after surgery. RESULTS： Two patients of observation group and one patient of control group withdrew from the study. Before surgery， there was no statistical significance in MAP and HR between 2 groups （P＞0.05）； 12， 24 h after surgery， MAP and HR of control group were significantly increased and higher than observation group， with statistical significance （P＜0.05）. There was no statistical significance in MAP and HR of observation group at different time points compared to before treatment； there was no statistical significance in MAP and HR between 2 groups immediately after surgery， 48 h after surgery （P＞0.05）. There was no statistical significance in VAS score between 2 groups immediately after surgery （P＞0.05）； 6， 12， 24， 48 h after surgery， VAS scores of observation group were significantly lower than those of control group， with statistical significance （P＜0.05）. There was no statistical significance in CD3+， CD4+， CD4+/CD8+ and NK cells levels between 2 groups before surgery （P＞0.05）. CD3+， CD4+ and NK cells levels of 2 groups immediately after surgery， CD3+， CD4+， CD4+/CD8+ and NK cells levels of 2 groups at 12， 24 h after surgery， CD3+ and CD4+ of control group at 48 h after surgery all changed significantly； CD3+， CD4+， CD4+/CD8+ and NK cells levels of observation group at 12， 24 h after surgery were significantly higher than those of control group， with statistical significantly （P＜0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： The parecoxib preemptive analgesia combined with postoperative epidural analgesia shows good analgesic effect for hip replacement patients， keeps their hemodynamics stable and protects immune function to certain extent with good safety. |
| 期刊： | 2017年第28卷第11期 |
| 作者： | 程财清，任何，施镔，冬飓 |
| AUTHORS： | CHENG Caiqing，REN He，SHI Bin，DONG Ju |
| 关键字： | 帕瑞昔布；超前镇痛；硬膜外镇痛；髋关节置换术；血流动力学；免疫功能 |
| KEYWORDS： | Parecoxib； Preemptive analgesia； Epidural analgesia； Hip replacement； Hemodynamics； Immune function |
| 阅读数： | 329 次 |
| 本月下载数： | 3 次 |
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