两种环氧化酶抑制剂在颈椎板成形术后的对比研究

摘要

目的：评价颈后路单开门椎管扩大椎板成形术后早期应用非选择性环氧化酶阻滞剂氟比洛芬酯注射液与选择性环氧化酶-2抑制剂注射用帕瑞昔布钠镇痛的有效性、安全性以及是否存在差异。方法前瞻性、随机、双盲、平行对照研究，根据纳入/排除标准，连续选取2010年3月至2013年3月在我科行颈后路单开门椎管扩大椎板成形术的患者60名，手术均采用全身麻醉，由同一组手术医师完成，两组病例均于切开皮肤前在手术切口周围注射“鸡尾酒”镇痛液（罗哌卡因注射液150 mg +肾上腺素（1：1000）0.5 mL，用生理盐水稀释为100 mL），帕瑞昔布钠组：术后6 h 开始给予帕瑞昔布钠40 mg，静注 q12 h，共6次。氟比洛芬酯组：术后6 h 开始给予氟比洛芬酯注射液100 mg，静注 q12 h，共6次。观察两组患者术后1~7 d 静息状态下和主动活动锻炼颈部最大屈伸位时的疼痛程度、颈部主动屈伸活动度、术后追加盐酸曲马多和盐酸哌替啶用量和发生不良反应例数、术后1个月复查时颈部屈伸活动度。结果术后1~7 d 在各观察点的静息状态和颈部最大主动屈伸位时的疼痛强度、颈部主动活动度、追加盐酸曲马多和盐酸哌替啶用量和发生不良反应例数及术后1个月颈部主动活动度的差异均无统计学意义（P ﹥0.05）。结论两种镇痛方案均效果良好，但不能认定颈后路单开门椎管扩大椎板成形术后短期镇痛中非选择性环氧化酶阻滞剂与选择性环氧化酶-2抑制剂之间存在差异。%Objective To evaluate the pain relief effect of parecoxib sodium(selective cyclooxygenase-2 inhibitor)versus flurbiprofen axetil(non-selective cyclooxygenase inhibitor)used after open door laminoplasty in early short-term fuctional re-covery. Methods This is a prospective,randomized,double-blind,parallel and controlled study. According to inclusion/ exclu-sion criteria,60 patients undergoing open door laminoplasty were randomly assigned to one of the 2 groups from March,2010 to March,2013. All the operations were performed by the same group of surgeons under general anesthesia. Before the open door laminoplasty operation incision“cocktail anagesia injection”was given to every patient,which contained 150 mg ropivacaine, 0. 5 mL epinephrine(1 : 1 000). The parecoxib sodium group received parecoxib sodium(40 mg,every 12 hours)after six hours of surgery,while the flurbiprofen axetil group received flurbiprofen axetil(100 mg,every 12 hours)after six hours of sur-gery,the pain score(visual analog scale,VAS)at rest and during activity,active range of motion of the cervical from the first to the seventh postoperative day,active range of motion of the cervical on postoperative day 30,the dose of tramadol hydrochloride and pethidine hydrochloride used postoperatively and adverse reaction happened postoperatively. Results There were no sig-nificant differences in such outcome measures as VAS scores at rest and during activity,active range of motion of the cervical from the first to the seventh postoperative day,active range of motion of the cervical on postoperative day 30,the dose of tram-adol hydrochloride and pethidine hydrochloride used postoperatively and adverse reaction. Conclusion Preoperative analgesia by using selective cyclooxygenase-2 inhibitor and non-selective cyclooxygenase inhibitor are effective for postoperative pain management after open door laminoplasty. This study has not revealed that there is better pain relief effect of parecoxib sodium than flurbiprofen axetil after open door laminoplasty in early short-term fuctional recovery.