塞来昔布对鼻内镜手术患者的术后镇痛效应

Efficacy of celecoxib for postoperative analgesia after endoscopic nasal surgery

目的 评价术前和术后口服塞来昔布对鼻内镜手术患者的术后镇痛效应.方法 拟在全麻下行鼻内镜手术患者120例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,性别不限,随机分为3组（n=40）：对照组（C组）、塞来昔布200 mg组（CEL1组）和塞来昔布400 mg组（CEL2组）.麻醉前1 h时,CEL1组口服塞来昔布200 mg,CEL1组口服塞来昔布400 mg,C组不给予任何处理.静脉注射咪达唑仑、异丙酚、瑞芬太尼和罗库溴铵行麻醉诱导,气管插管后行机械通气.静脉输注异丙酚和瑞芬太尼维持麻醉.术毕送入麻醉恢复室（PACU）,当VAS评分≥3分时,静脉注射芬太尼25μg/次,间隔5～10 min,直至VAS评分＜3分.返回病房后,CEL1组和CEL2组口服塞来昔布200 mg,2次/d,连续5 d.当VAS评分≥4分时,口服羟考酮5 mg/次,直至VAS评分＜4分.记录PACU期间芬太尼的使用情况、术后6 h内、6～24 h、2～5 d羟考酮的使用情况和术后不良反应的发生情况.术后5 d时评价患者镇痛满意情况,计算镇痛满意率.于术毕、术后6、48 h时,采集肘静脉血样,采用放射免疫法测定血浆前列腺素E2（PGE2）、6-酮-前列腺素F1α（6-k-PGF1α）和血栓烷素B2（TXB2）的浓度,计算TXB2/6-k-PGF1α.结果 与C组比较,CEL1组和CEL2组PACU期间芬太尼使用率和术后6 h内、6～24 h羟考酮使用率降低,患者镇痛满意率升高,术后48 h时血浆PGE2浓度降低（P＜0.05或0.01）;CEL1组和CEL2组各指标比较差异无统计学意义（P＞0.05）.各组各时点TXB2/6-k-PGF1α比较差异无统计学意义（P＞0.05）.C组术后有1例患者发生恶心呕吐,CEL1组和CEL2组未见不良反应的发生.结论 术前和术后口服塞来昔布可减轻鼻内镜手术患者术后疼痛,其机制与降低血液PGE2浓度有关.

Objective To investigated the efficacy of celecoxib for postoperative analgesia after endoscopic nasal surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients of both sexes aged 18-64 yr were randomly assigned to one of three groups （ n = 40 each）： control group （ group C）; celecoxib 200 group （ group CEL1 ） and celecoxib 400 group （ group CEL2 ）. The patients took celecoxib 200 and 400 mg by mouth at 1 h before induction of anesthesia in group CEL1 and CEL2 respectively. Anesthesia was induced with midazolam,propofol, remifentanil and rocuronium and maintained with iv propofol and remifentanil infusion. VAS was used to assess postoperative pain （0 = no pain, 10 = worst pain）. In PACU when VAS score ≥3, the patients were given fentany125 μg iv every 5-10 min until the VAS score 〈 3. After being discharged from PACU, the patients received celecoxib 200 mg every 12 h for 5 days in the 2 celecoxib groups. Oxycodone 5 mg was used as rescue analgesic when VAS score ≥ 4 until the VAS score 〈 4. The number of patients who needed fentanyl for analgesia in PACU, the number of patients who needed oxycodone within 6 h, 6-24 h and day 2-5 after operation and side effects after operation were recorded. Analgesic efficacy was assessed at day 5 after operation and the satisfactory rate of patients calculated. Blood samples were obtained at 0, 6 and 48 h after operation for determination of PGE2,6-k-PGF1α and TXB2 concentrations. TXB2/6-k-PGF1α was calculated. Results The number of patients who needed fentanyl in PACU and the number of patients who needed oxycodone within 6 h and 6-24 h after operation were less, the satisfactory rate was significantly higher, and PGE2 concentrations in blood were significantly lower at 48 h after operation in the 2 celecoxib groups than in group C （ P 〈 0.05 or 0.01 ）. There was no significant difference in each index between the 2 celecoxib groups （ P 〉 0.05 ）. There was no significant difference in TXB2/6-k-PGF1α at each time point among the three groups. Nausea and vomiting occurred in one patient after operation in group C, but side effects were not observed in the 2 celecoxib groups. Conclusion Celecoxib given before and after operation can effectively relieve postoperative pain after endoscopic nasal operation by reducing PGE2 concentrations in blood.