帕瑞昔布防止瑞芬太尼全身麻醉苏醒期躁动及对术后镇痛的影响

Effects of parecoxib on emergence agitation after remifentanil-based anesthesia and postoperative analgesia

目的了解帕瑞昔布对防止瑞芬太尼全身麻醉(全麻)手术患者苏醒期躁动的效果,评价其对术后静脉自控镇痛的影响。方法拟于全麻下行妇科及骨科手术的50例患者随机分为2组,每组25例。所有患者均采用静吸复合麻醉,术中持续静脉泵注瑞芬太尼。开始缝合皮肤时帕瑞昔布组静脉注射帕瑞昔布40 mg并复合吸入七氟烷直至皮肤缝合结束。对照组静脉泵注瑞芬太尼并复合吸入七氟烷直至皮肤缝合结束。术毕开始自控静脉镇痛。观察给药后不同时点的平均动脉压(MAP)和心率(HR)。记录手术时间、拔管时间、恢复期躁动情况,术后48 h内不同时点疼痛评分、自控镇痛效果的总体评价,并观察药物不良反应。结果帕瑞昔布组术毕10 min至拔管前MAP和HR均低于对照组(P<0.05)。对照组苏醒期躁动发生率(24%)高于帕瑞昔布组(4%,P<0.05)。帕瑞昔布组患者出恢复室至回病房后4 h内VAS静态评分均低于对照组(P<0.05),动态评分回病房后1～4 h低于对照组(P<0.05)。2组均未见严重不良反应发生。结论帕瑞昔布能减少瑞芬太尼全麻苏醒期躁动,有益于完善术后早期自控镇痛效果。

AIM To study the effects of parecoxib on emergence agitation after remifentanil-based anesthesia,and evaluate its efficacy on postoperative analgesia.METHODS Fifty patients undergoing abdominal gynecologic or orthopedics surgery under general anesthesia were randomized into two groups（n = 25 in each）.Combined intravenous and inhalation anesthesia were performed to patients in both groups and remifentanil was continuously pumped.Patients in the parecoxib group were intravenously administered with parecoxib 40 mg when starting to sew up skin incision,and with sevoflurance till the end of the operation.Patients in the control group were administered with remifentanil combined with sevoflurane till the end of the operation.Post-operative analgesia was obtained by a patient-controlled intravenous pump.MAP,HR were measured at different time points after parecoxib administration.Surgical time and extubation time were recorded,and emergence agitation was observed.The score of pain and the efficacy of patient controlled intravenous analgesia were recorded within the first 48 h postoperatively.Adverse reactions were observed.RESULTS MAP and HR in the parecoxib group were lower than those in the control group from 10 min after operation to extubation（P 0.05）.Incidence of emergence agitation in the control group（24%） was significantly higher（P 0.05） than that in the parecoxib group（4%）.The static visual analog scale（VAS） score in the parecoxib group was lower than that in the control group within the first 4 hours after discharge from post-anesthesia care unit（P 0.05）,as well as the dynamic VAS score during the 1-4 h in the ward（P 0.05）.No serious adverse reactions were found in the present study.CONCLUSION Intravenous administration of parecoxib could reduce the incidence of emergence agitation,and is beneficial for the improvement of early patient controlled analgesia effect.