帕瑞昔布钠超前镇痛在经腹胆囊切除术中的应用

Efficacy of parecoxib for preemptive analgesia in cholecystectomy

目的探讨帕瑞昔布钠预先注入对经腹胆囊切除患者术后镇痛效果的影响。方法选择经腹胆囊切除患者80例,ASAⅠ～Ⅱ级,随机分为帕瑞昔布钠超前镇痛组(A组)和帕瑞昔布钠术后镇痛组(B组),每组40例。所有患者均采用静吸复合全身麻醉。两组患者分别在麻醉诱导前和关腹时静注帕瑞昔布钠40mg,手术结束时,接芬太尼自控静脉镇痛泵(PCIA)。采用VAS评分法评估患者术后0、1、2、4、8、12、24h疼痛程度,并记录应用PCIA镇痛药物的总量。记录手术时间、麻醉苏醒时间及不良反应等情况。结果A组患者在术后0、1、2、4、8、12、24hVAS评分均低于B组(P<0.05),且术后24h内需要PCIA镇痛药的总量少于B组(P<0.05)。两组患者手术时间、麻醉苏醒时间及不良反应发生率差异无统计学意义(P>0.05)。结论帕瑞昔布钠超前镇痛可以产生较好的术后镇痛效果,同时可减少阿片类药物的应用。

Objective To evaluate the effects of parecoxib for preemptive analgesia in patients undergoing cholecystectomy. Methods Eighty patients undergoing cholecystectomy were randomly divided into two groups： group A and group B. Patients in group A（ n = 40） received parecoxib 40 mg before induction; patients in group B（ n = 40） received the same dose after peritoneum closure. A standardized general anesthetic was used. All patients were started on patient control veins analgesia（ PCIA） when awaked after tracheal extubation. The effectiveness was assessed postoperatively using the visual analogue scale（ VAS） at 0、1、2、4、8、12、24 hours after surgery,and by calculating the PCIA total analgesic consumption of fentanil in the first 24 hours following operation. Time to first analgesic request,operative and palinesthesia, side effects were also recorded. Results The VAS of patients in group A was significantly lower（ P 0. 05） than group B at all time intervals. There were fewer patients in the preemptive group than comparative group who required total PCIA analgesic consumption within the first 24 hours（ P 0. 05） . There was no significant difference between the two groups in operation time,palinesthesia time and side effets（ P 0. 05） . Conclusion Parecoxib administered preemptively can improve the quality of postoperative analgesia and reduce consumption of opioid analgesics postoperatively in patients undergoing cholecystectomy.