【作者】 张旭；

【导师】 李世宽；

【作者基本信息】 青岛大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的观察塞来昔布超前镇痛用于腹股沟疝无张力修补术的效果,评估其在腹股沟疝无张力修补术应用中的有效性和安全性。方法(1)收集青岛市中心医院疝和腹壁外科自2016年1月-12月100例择期行单侧腹股沟疝无张力修补术的男性患者,将其随机分为治疗组(A组)和对照组(B组),每组各50例,治疗组于术前24h和12h分别口服塞来昔布200mg,术后不用药,对照组术前、术后均不用药。治疗组和对照组两组患者均行腹股沟疝无张力修补术,而且都使用同等剂量的利多卡因注射液进行局部浸润麻醉来完成手术。(2)两组患者均于术后2、4、8、12采用视觉模拟评分(VAS)和最高VAS评分对患者疼痛程度进行疼痛分级评分。(3)对比两组患者的术后各项指标,其包括术后使用补救性镇痛药物曲马多的例数、术后的各类不良反应,平均的术后住院时长,患者手术结束时及术后24h分别抽取外周血2m L,测定外周血Hs-CRP水平。结果(1)治疗组患者术后2、4、8、12 h的VAS评分及术后最高VAS评分均低于对照组,差异有统计学意义(P<0.05);(2)术后治疗组和对照组分别有3例和11例患者使用曲马多,差异有统计学意义(χ2=5.175,P=0.023);治疗组和对照组患者术后分别有2例和8例患者发生不良反应,差异有统计学意义(χ2=3.927,P=0.048);治疗组术后住院时间短于对照组(P<0.05);(3)分别统计两组患者手术结束时及术后24h外周血超敏C-反应蛋白(Hs-CRP)的水平,结果证实治疗组Hs-CRP水平明显低于对照组,差异有统计学意义(P<0.05)。结论塞来昔布作为目前临床上常用的超前镇痛药物,其术后镇痛效果确切,患者满意度较高,不良反应明显减少,有利于患者早日康复,可以广泛的应用于腹股沟疝无张力修补术。更多还原

【Abstract】 Objective: To evaluate the preemptive analgesic efficiency of celecoxib on patients undergoing inguinal hernia repair.Methods:(1)One hundred patients come from Qingdao central hospital who scheduled for surgery between January and December 2016 were randomized into group A(n=50)and group B(n=50).All the patients are male.Patients in group A oral celecoxib capsule(200 mg)for 24 h and 12 h before surgery while group B not use anything.All patients underwent tension-free hernia repair under local anesthesia with simplex lidocaine;(2)Visual analogy scores(VAS)after surgery and the maximum VAS were recorded;(3)The number of patients requiring rescue analgesic(tramadol oral)or with adverse effects related to analgesia were observed and recorded.Postoperative hospital stay with analgesic effect were compared between the two groups.Concentrations of plasma hypersensitive C-reactive protein(Hs-CRP)after surgery and 24 hours after surgery were measured in both groups.Results:(1)VAS score of 2,4,8 and 12 h after operation in patients with group A was lower than that in group B,the difference was statistically significant(P<0.05);(2)The number of patients requiring tramadol(3/50)or with adverse effects(2/50)in group A were significantly lower than that in group B(11/50 and 8/50respectively).Postoperative hospital stay was shorter in group A than in group B;(3)There were significant differences in concentration of plasma Hs-CRP between the two groups after surgery and after 24 hours of the surgery(P<0.05).Conclusion:Preemptive administration of celecoxib for hernia repair can result in significant analgesic effect with fewer adverse effects,higher patient satisfaction and faster recovery.更多还原