帕瑞昔布和罗哌卡因对妇科腹腔镜术后镇痛的影响

Effects of parecoxib and ropivacaine on gynecologic analgesia after laparoscopic surgery

目的:比较帕瑞昔布、罗哌卡因单独或联合应用对腹腔镜下妇科手术的术后镇痛效果。方法:80例女性患者拟在腹腔镜下行妇科手术,患者随机分成A、B、C、D组。A组为帕瑞昔布40mg,B组局部浸润0.5%罗哌卡因20ml,C组帕瑞昔布40mg及局部浸润0.5%罗哌卡因20ml,D组采用生理盐水2ml肌肉注射作为对照。观察血压、心率、脉搏血氧饱和度,术后1、3、6、12、24h各时间点的疼痛情况,术后疼痛观察采用视觉模拟评分法(VAS,0～10)。记录需要补充哌替啶的患者人数,用方差分析比较各组间的VAS评分。结果:术后1hA、B、C组VAS评分均低于D组(P<0.05),其中C组低于A、B组(P<0.05);术后3、6hA、B、C组之间VAS评分差异无统计学意义,均低于D组(P<0.05);术后12h和24h4组的差异无统计学意义(P>0.05)。4组患者术后24h内需要补充镇痛药物哌替啶的人数是A组4人(20%),B组3人(15%),C组3人(15%),D组8人(40%),A、B、C组需要补充镇痛药的患者比D组少,(P<0.05)。结论:帕瑞昔布、罗哌卡因单独或联合应用对腹腔镜下妇科手术的术后镇痛有良好效果,其中联合应用的早期镇痛效果最好。

Objective：To compare the analgesic effects of parecoxib and ropivacaine alone or in combination on gynecologic analgesia after laparoscopic surgery.Methods：80 female patients undergoing gynecologic surgery under laparoscope were divided into four groups randomly： the patients in A group were treated with 40 mg parecoxib, the patients in B group were treated with local infiltration of 0.5% ropivacaine （20 ml）, the patients in C group were treated with 40 mg parecoxib and local infiltration of 0.5% ropivacaine （20 ml）, the patients in D group were treated with intramuscular injection of 2 ml normal saline as control group; blood pressure, heart rate, pulse oxygen saturation and pain scores at 1, 3, 6, 12 and 24 hours after surgery were observed, visual analogue scale （VAS, 0～10） was used in the study, the number of patients needing supplement of pethidine was recorded, variance analysis was used to compare the VAS scores among the four groups.Results：At 1 hour after surgery, VAS scores in A, B and C groups were significantly lower than that in D group （P0.05）, VAS score in C group was significantly lower than those in A and B groups （P0.05）; at 3 and 6 hours after surgery, there was no significant difference in VAS score among A, B and C groups, but VAS scores in A, B and C groups were significantly lower than that in D group （P0.05）; at 12 and 24 hours after surgery, there was no significant difference in VAS score among A, B, C and D groups （P0.05）; the numbers of patients needing supplement of pethidine in A, B, C and D groups were 4 （20%）, 3 （15%）, 3 （15%） and 8 （40%）, respectively; the numbers of patients needing supplement of pethidine in A, B and C groups were significantly fewer than that in D group （P0.05） .Conclusion：The analgesic effects of parecoxib and ropivacaine alone or in combination on gynecologic analgesia after laparoscopic surgery are good, early analgesic effects of combined application is the best.