帕瑞昔布钠在甲状腺手术中镇痛效果的观察

Efficacy of parecoxi-sodium analgesia in thyroid surgery patients

目的观察帕瑞昔布钠在甲状腺手术围术期镇痛的临床效果。方法 75例甲状腺手术病人随机分成A组、B组和C组,每组25例,均采用颈丛复合靶控输注瑞芬太尼麻醉。A组在手术开始前15min静注帕瑞钠昔布40mg,B组在手术结束后静注帕瑞昔布钠40mg,C组在手术结束后静注等量生理盐水,观察术中患者血压、心率、血氧饱和度、镇静程度、瑞芬太尼用药量,同时记录术中、术后VAS评分和不良反应。结果 3组病人在手术开始15min后,血压、心率明显上升(P<0.05),B组和C组病人较A组上升更明显(P<0.05);A组病人术中瑞芬太尼的用量明显小于B组和C组(P<0.05),术中呼吸抑制的病例数明显小于B组和C组(P<0.05),术中牵拉反应明显低于B组和C组(P<0.05),术中满意度优于B组和C组(P<0.05);三组病人术中躁动、术后恶心呕吐差异无显著性(P>0.05);A组病人在手术12 h后各时点吞咽痛明显轻于B组(P<0.05),C组病人在术后各时点吞咽痛均明显重于A组和B组(P<0.05)。结论应用帕瑞昔布钠可以明显减轻甲状腺手术围术期的疼痛,术前应用效果更好。

OBJECTIVE To investigate the effectiveness of parecoxi-sodium treatment in thyroid gland surgery for perioperative analgesia.METHODS 75 cases of patients scheduled for thyroid gland surgery were randomly divided into group A,group B and group C,25 cases in each group.All the patients were received target-controlled remifentanil infusion combined with cervical plexus block.group A patients received Intravenous parecoxi-sodium 40mg 15 minutes earlier before operation,group B patients received Intravenous parecoxi-sodium 40mg immediately after operation,and group C received int ravenous equivalence saline immediately after operation.The blood pressure,heart rate,oxygen saturation,depth of sedation of the patients and volume of remifentanil used for the patients were observed during the operation,and the intraoperative and postoperative VAS score and adverse reaction were recorded simultaneouly.RESULTS The blood pressure and heart rate of all patients in three groups increased obviously 15 minutes later after the operation began（P0.05）.Compaired with that of patients in group A,the blood pressure and heart rate of patients in group B and group C increased more obviously（P0.05;Volume of remifentanil used for the patients in group A was less than that for patients in group B and group C obviously（P0.05）;Cases of respiratory depression in group A were less than that in group B and group C obviously（P0.05）;Occurrence of traction reaction in group A was less than that in group B and group C obviously（P0.05）;Patients in group A showed superior satisfaction to those in group B and group C during operation（P0.05）;Occurrence of intraoperative restlessness,postoperative nausea and vomiting in all the three groups showed no significant difference（P0.05）;Patients in group A complained of obviously less severe pain when swallowing than that in group B on each time point 12 hours later after the operation（P0.05）;While patients in group C complained of obviously more severe pain when swallowing than that in both group A and group B（P0.05）.CONCLUSION Parecoxi treatment could alleviated the pain of patients undergoing thyroid gland surgery at the perioperative period;The result of analgesia could be better when parecoxi-sodium treatment was used for patients before operation.