王海兴;林子洪;陈桂浩;王良泽;沈梓维;郑秋坚;

• 1:广东省医学科学院广东省人民医院骨科
• 2:南方医科大学第二临床医学院

摘要(Abstract)：

[目的]研究塞来昔布对全髋关节置换患者术前疼痛程度及疼痛敏感度的影响,比较塞来昔布对健侧与患侧下肢疼痛敏感度的影响,探究塞来昔布用药前后疼痛程度的变化与疼痛敏感度的变化之间有无相关性,探讨塞来昔布能否通过影响患者术前疼痛状态而发挥预防性镇痛作用。[方法]以广东省人民医院骨科拟行单侧全髋关节置换术术前患者为评估对象,排除股骨颈骨折、术前2周曾服用过镇痛类药物、糖尿病、腰椎间盘突出等影响下肢感觉疾病的患者,并经匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)、抑郁自评量表(self-rating depression scale,SDS)及焦虑自评量表(self-rating anxiety scale,SAS)评分后筛选患者40例,随机分为塞来昔布组、维生素C组,各20例。塞来昔布组患者入院后第2~4 d口服塞来昔布(200 mg,2次/d),维生素C组患者入院后第2~4 d口服维生素C(200 mg,2次/d),分别于入院当晚(服药前天晚上)及服药后第3 d晚采用视觉模拟评分法(visual analogue scale,VAS)评定患者患肢静息及活动时的疼痛程度,并用痛阈测量仪测量患者双侧下肢痛阈及耐痛阈值。测量过程遵循随机双盲对照原则。[结果]塞来昔布组患者服用塞来昔布3 d后患肢静息及运动状态下VAS评分的变化不具统计学意义(P>0.05),健侧及患侧下肢痛阈值较服药前有所提高(P<0.05),服药前后患侧痛阈的变化较健侧更加明显(P<0.05),健侧及患侧下肢耐痛阈较用药前无明显变化(P>0.05);塞来昔布组患者用药前后患侧痛阈变化差值与静息VAS评分变化差值(rs=-0.529,P=0.016)、运动VAS评分变化差值(r=-0.463,P=0.040)呈负相关关系,耐痛阈变化差值与静息及运动VAS评分变化差值的相关性无统计学意义;维生素C组患者服药前后的VAS评分、痛阈及耐痛阈较用药前均无明显变化(P>0.05);[结论]塞来昔布可有效提高全髋关节置换患者的术前痛阈,对患侧下肢痛阈的影响较健侧更为明显,但对静息及运动状态下的VAS评分及耐痛阈无明显影响。塞来昔布用药前后患者的疼痛程度变化与疼痛敏感度的变化之间存在负相关。塞来昔布可能通过提高全髋关节置换患者的术前痛阈而发挥预防性镇痛作用。今后的课题可进一步使病种单一化,扩大样本量,将研究范围扩展至整个围术期,更直接地研究术前敏感度的变化与术后疼痛之间的关系,进一步验证塞来昔布预防性镇痛的有效性。

关键词(KeyWords)： 塞来昔布;预防性镇痛;VAS;痛阈;耐痛阈

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王海兴;林子洪;陈桂浩;王良泽;沈梓维;郑秋坚;

Email:

DOI:

参考文献(References)：

• [1]Katz J,Clarke H,Seltzer Z.Review article:preventive analgesia:quo vadimus[J].Anesth Analg,2011,5:1242-1253.
• [2]Nielsen PR,Norgaard L,Rasmussen LS,et al.Prediction of post-operative pain by an electrical pain stimulus[J].Acta Anaesthesiol Scand,2007,5:582-586.
• [3]Hsu YW,Somma J,Hung YC,et al.Predicting postoperative pain by preoperative pressure pain assessment[J].Anesthesiology,2005,3:613-618.
• [4]杨林,郭艾,徐本明,等.西乐葆超前镇痛在髋关节置换手术的应用[J].中国矫形外科杂志,2007,14:1065-1068.
• [5]Chesterton LS,Barlas P,Foster NE,et al.Gender differences in pressure pain threshold in healthy humans[J].Pain,2003,3:259-266.
• [6]Helme RD,Meliala A,Gibson SJ.Methodologic factors which contribute to variations in experimental pain threshold reported for older people[J].Neurosci Lett,2004,1-3:144-146.
• [7]Azevedo E,Manzano GM,Silva A,et al.The effects of total and REM sleep deprivation on laser-evoked potential threshold and pain perception[J].Pain,2011,9:2052-2058.
• [8]Chiu YH,Silman AJ,Macfarlane GJ,et al.Poor sleep and depression are independently associated with a reduced pain threshold.Results of a population based study[J].Pain,2005,3:316-321.
• [9]Fardal O,Mcculloch CA.Impact of anxiety on pain perception associated with periodontal and implant surgery in a private practice[J].J Periodontol,2012,9:1079-1085.
• [10]Colloca L,Benedetti F.Nocebo hyperalgesia:how anxiety is turned into pain[J].Curr Opin Anaesthesiol,2007,5:435-439.
• [11]Aasvang EK,Hansen JB,Kehlet H.Can preoperative electrical nociceptive stimulation predict acute pain after groin herniotomy[J].J Pain,2008,10:940-944.
• [12]Pan PH,Coghill R,Houle TT,et al.Multifactorial preoperative predictors for postcesarean section pain and analgesic requirement[J].Anesthesiology,2006,3:417-425.
• [13]Granot M,Lowenstein L,Yarnitsky D,et al.Postcesarean section pain prediction by preoperative experimental pain assessment[J].Anesthesiology,2003,6:1422-1426.
• [14]Poobalan AS,Bruce J,Smith WC,et al.A review of chronic pain after inguinal herniorrhaphy[J].Clin J Pain,2003,1:48-54.
• [15]Aasvang EK,Brandsborg B,Christensen B,et al.Neurophysiological characterization of postherniotomy pain[J].Pain,2008,1:173-181.