关键词: 帕瑞昔布钠, 超前镇痛, 髋关节置换术, IL-6, TNF-α

Abstract: Objective To investigate the affected inlfammatory cytokines of preemptive analgesia with parecoxib sodium on the patients with hip replacement, and observe the postoperative analgesia. Methods 60 cases aged 40 to 65 years, ASAⅠ-Ⅱgrade, under general anesthesia for elective hip arthroplasty were randomly divided into observation group and control group, 30 cases in each group. Before general anesthesia for 20 min, the patients of observation group were injected parecoxib sodium 40 mg (diluted with saline to 4 mL) intravenously, the patients of control group were given saline 4 mL intravenously. Before bolus parecoxib sodium or saline 10 min (T1), end of the surgery (T2), after 6 h (T3), Postoperative 12 h (T4), Postoperative 24 h (T5) Exsanguinate vein blood samples and detecting the inlfammatory cytokine interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) in the plasma concentrations respectively. Using a visual analogue scale (VAS) evaluation of surgery immediately, after operation for 2 h, 6 h, 12 h, 24 h analgesic effects were observed . Results Inlfammatory cytokines:The IL-6 plasma concentration of the two groups were signiifcantly higher at the time point T3,T4 and T5 than pre-operation. There was statistical difference between the 2 groups(P<0.05). The IL-6 plasma concentration of the experimental group at the time point T3,T4 and T5 was obviously lower than that of the control group(P<0.05). The TNF-αplasma concentration of the two groups were signiifcantly higher at the time point T4 and T5 than pre-operation (P<0.05). The TNF-αplasma concentration of the experimental group at the time point T4 and T5 were obviously lower than that of the control group and there was statistical difference(P<0.05). Stress hormone concentration:The plasma concentration of the two groups at the different time point were clearly higher than that before operation and there was statistical difference(P<0.05). The plasma concentration of the experimental group at the different time points T2,T3, T4 and T5 were obviously lower than that of the control group. The plasma E concentration of the two groups at the time point T2 were obviously higher than that before operation. The plasma E concentration of the experimental group at the time point T2 were obviously lower than that of the control group and there was statistical difference(P<0.05). The evaluation result of VAS: The VAS evaluation results of the experimental group at the different time points---the very end of the operation, 2h, 6h,12h after the operation, were significantly lower than that of the control group and there was a significant difference between the 2 groups (P<0.05). Conclusion Parecoxib sodium preemptive analgesia can relieve postoperative pain in total hip arthroplasty patients, inhibit the release of inlfammatory mediators, reduce the sensitivity of the nervous system, which will help the rehabilitation of patients after surgery.

Key words: parecoxib sodium, preemptive analgesia, total hip replacement, IL-6, TNF-α