帕瑞昔布钠联合曲马多对老年全胸腔镜肺叶切除术患者麻醉效果观察

Anesthesia effect of parecoxib sodium combined with tramadol in elderly patients undergoing thoracoscopic lobectomy

目的伴随医学技术的不断进步,胸腔镜手术凭借其手术创伤小、操作简单和感染率低等优点在肺叶切除术中得到广泛应用。本研究探讨帕瑞昔布钠联合曲马多对老年全胸腔镜肺叶切除术患者围手术期炎症应激及肺功能指标的影响。方法选择2015-03-12-2019-03-28福建省立医院收治的行全胸腔镜肺叶切术的120例老年患者为研究对象。采用组间匹配的方法分为对照组、帕瑞昔布钠组和帕瑞昔布钠联合曲马多组,每组40例。帕瑞昔布钠组术前30min给予40mg帕瑞昔布钠;帕瑞昔布钠联合曲马多组术前30min给予40mg帕瑞昔布钠,并与手术结束前20min给予曲马多2mg/kg;对照组静脉注射等量生理盐水。比较3组患者术前(T0)、术毕(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)患者血清白介素-6(interleukin 6,IL-6)、白介素-8(interleukin 8,IL-8)水平、呼吸功能指标、视觉模拟量表(visual analogue scale,VAS)疼痛评分和不良反应发生情况。结果术后对照组IL-6和IL-8水平升高,帕瑞昔布钠组和联合组IL-6和IL-8水平均低于于对照组,差异有统计学意义,IL-6:F组间=7.31,P<0.05,F时间=5.15,P<0.05;IL-8:F组间=6.89,P<0.05,F时间=6.01,P<0.05。术后帕瑞昔布钠组和联合组1和3d的第1秒用力呼气量占用力肺活量比值高于对照组,差异有统计学意义,F组间=4.66,P<0.05,F时间=5.87,P<0.05。术后各时间点,帕瑞昔布钠组和联合组VAS疼痛评分均低于对照组,术后联合组VAS疼痛评分低于帕瑞昔布钠组,F组间=4.15,P<0.05;F时间=6.65,P<0.05。联合组、帕瑞昔布钠组和对照组术后不良反应发生率分别为7.5%、5.0%和2.5%,差异无统计学意义,χ2=1.05,P>0.05。结论采用帕瑞昔布钠联合曲马多对行全胸镜肺叶切除术的老年患者进行麻醉镇痛效果确切,能明显减轻术后炎症反应,改善患者围术期疼痛和呼吸功能,安全性较好。

OBJECTIVE With the development of medical technology,thoracoscopic surgery has been widely used in lobectomy because of its advantages of small trauma,simple operation and low infection rate.The purpose of this study was to investigate the effect of parecoxib sodium combined with tramadol on perioperative inflammatory stress and pulmonary function in elderly patients undergoing total thoracoscopic lobectomy.METHODS From March 12,2015 to March28,2019,a total of 120 elderly patients who underwent whole thoracoscopic lobectomy in Fujian Provincial Hospital were selected as the study objects.The patients were divided into control group,parecoxib sodium group and parecoxib sodium combined with tramadol group.In the parecoxib sodium group,40 mg of parecoxib sodium was given 30 minutes before operation;in the parecoxib sodium combined with tramadol group,40 mg of parecoxib sodium was given 30 minutes before operation,and 2 mg/kg of tramadol was given 20 minutes before operation;in the control group,the same amount of normal saline was injected intravenously.The levels of IL-6,IL-8,respiratory function index,visual analog scale(VAS)pain score and adverse reactions were compared before operation(T0),at the end of operation(T1),6 hafter operation(T2),12 hafter operation(T3)and 24 hafter operation(T4).RESULTS The level of IL-6 and IL-8 in the control group increased after operation,and the water level of IL-6 and IL-8 in the parecoxib sodium group and the combined group was lower than that in the control group,the difference was statistically significant,IL-6:Intergroup F=7.31,P<0.05,time F=5.15,P<0.05;IL-8:Intergroup F=6.89,P<0.05,time F=6.01,P<0.05.The first second forced expiratory volume accounts for the percentage of forced vital capacity of parecoxib sodium group and combined group were higher than that of the control group in 1 dand 3 d,the difference was statistically significant,Intergroup F=0.466,P<0.05,time F=5.87,P<0.05.At each time point after operation,the VAS pain score of parecoxib sodium group and combination group was lower than that of the control group,the VAS pain score of combination group was lower than that of parecoxib sodium group,Intergroup F=4.15,P<0.05;time F=6.65,P<0.05.The incidence of postoperative adverse reactions in combination group,parecoxib sodium group and control group were 7.5%,5.0%and2.5%,respectively,with no significant difference.CONCLUSION Parecoxib sodium combined with tramadol for anesthesia and analgesia in elderly patients undergoing total thoracoscopic lobectomy can significantly reduce postoperative inflammatory response,improve perioperative pain and respiratory function,and has good safety.