Objective To evaluate the efficacy of intramuscular parecoxib for postoperative analgesia in patients undergoing total knee arthroplasty.Methods Fifty-four ASA Ⅰ-Ⅲ patients,aged 65-75 yr,scheduled for unilateral total knee arthroplasty,were randomly divided into 2 groups (n =27 each)∶ tramadol group (group T) and parecoxib group (group P).Total intravenous anesthesia was used in both groups.Group P received intramuscular injection of parecoxib 40 mg at 12 h before operation and 12,24,36,48,60 and 72 h after operation,and group T received tramadol 100 mg at the same time points.When VAS score was more than 3 after operation,intramuscular parecoxib 50 mg was given as rescue analgesic.The ineffective analgesia at rest and during activity was recorded.The time for knee range of motion to reach 90° and cardiovascular events were recorded.The ultrasonic inspection was performed on veins of the bilateral lower extremities at 7 and 14 days after operation for detection of vein thrombosis.Results Compared with T group,the rate of ineffective analgesia at rest and during activity was significantly decreased,the time for knee range of motion to reach 90° was shortened,and the incidence of deep vein thrombosis was significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidences of cardiovascular events and intramuscular venous thrombosis in group P (P ＞ 0.05).Conclusion Parecoxib 40 mg injected intramuscularly before and after operation can significantly relieve postoperative pain,is helpful for the hip function rehabilitation and can reduce the occurrence of deep vein thrombosis in patients undergoing total knee arthroplasty.

Abstract: To investigate the influence of acute myocardial infarction(AMI) combined with hypertension on its circadian rhythm. Methods: A total of 1 006 cases of AMI who underwent emergency percutaneous coronary intervention(PCI) surgery were collected continuously, and they were divided into a combined hypertension group and a non-combined hypertension group according to whether it was combined with hypertension. The day was divided into 4 and 12 time periods in units of 6 hours and 2 hours, and the number of cases and differences between the two groups in each time period were compared. Results: After propensity score matching(PSM), the two groups had different onsets in the 4 time periods of 0:00—5:59, 6:00—11:59, 12:00—17:59 and 18:00—23:59(P=0.014,0.045,0.035,0.016). After further subdividing the time into 12 time periods in units of 2 hours, the morning peak of the onset time of the hypertensive group was 10:00—11:59(P=0.004), and there was another peak at 2:00—3:59 in the morning(P=0.002). Multivariate Logistic regression indicated that compared with non-combined hypertension, AMI with hypertension had an increased risk of onset in the morning(6:00—11:59)(OR, 1.440; 95%CI, 1.089-1.904;P=0.011). Conclusion Hypertension affects the circadian rhythm of the onset of AMI and the peak time of onset, and it is a risk factor for the onset of AMI in the morning peak period(6:00—11:59).