帕瑞昔布钠抑制瑞芬太尼麻醉后痛觉过敏的临床研究

The suppressive effects of parecoxib on the patients with postoperative hyperalgesia after remifentanilbased Anesthesia

目的探讨帕瑞昔布钠对瑞芬太尼麻醉后痛敏反应的抑制作用，为临床合理应用瑞芬太尼提供理论指导。方法选择ASAⅠ-Ⅱ级腹腔镜手术患者60例，随机分为对照组（A组）和帕瑞昔布钠组（B组）两组，每组30例。均采用静吸复合麻醉，两组诱导方法相同，以0．2～0．4μg/（kg·min）瑞芬太尼和1．5％～3％七氟烷维持麻醉。B组在缝皮前静脉给予帕瑞昔布钠40mg，记录两组术前（T0）、术毕（T1）、苏醒（T2）、拔管即刻（T3）、拔管后10min（T4）及拔管后30min（T5）血压（MAP）、心率（HR）、血氧饱和度（SpO2）以及术后苏醒时间、拔管时间、Ramsay评分、口述疼痛评分（VRS）和不良反应。结果A组患者T2、T3、T4及T5时点的MAP、HR均高于T0（P〈0．05），且高于B组（P〈0．05）。B组患者苏醒时Ramsay评分和VRS评分均明显优于A组（P〈0．05）。两组患者术后均无明显的呼吸抑制和恶心呕吐的发生，但B组患者术后躁动率明显低于A组（P〈0．05）。结论帕瑞昔布钠对瑞芬太尼麻醉后的痛觉过敏有明显的抑制作用，且不增加不良反应。

Objective To study the suppressive effects of parecoxib on postoperative hyperalgesia after remifentanil-based anesthesia. Methods 60 ASA grade Ⅰ - Ⅱ patients undergoing selective laparoseopic operations were randomly divided into two groups （n = 30 ） ：controlled group （group A ） and pareeoxib group B （group B）. Midazolam（0. 05 mg/kg）,remifentanil （llxg/kg）,propofol （2 mg,/kg） and atracrium （0. 6 mg/kg） were adnfinistered for anesthesia induction, and 0. 2 - 0.4μg/（ kg · min） remifentanil and 1.5% - 3% sevoflurane were given for anesthesia maintenance in the two groups. At skin closure parecoxib 40 mg was intravenous injected in group B, and group A received no drug infusion. MAP, HR and SpO2 was recorded at the time points of entering the operation room （ TO ） , completion of the operation （ T1 ） , wake up （ T2 ） , extubation （ T3 ）, 10 minutes after extubation （ T4 ） and 30 minutes after extubation （ T5 ）. The time of awake, the time of extubation and the adverse effects were recorded. The Ramsay sedation score and VRS score were evaluated. Results In group A, MAP and HR of T2, T3 T4 and T5 were remarkable higher than T0 （ P 〈 0. 05 ）, and also higher than those of group B （ P 〈 0. 05 ）. The Ramsay sedation score and VRS score in group B were much better than those in group A （ P 〈 0. 05 ）. Compared with group A, the rate of restlessness of group B was obviously lower（ P 〈 0. 05 ）. Conclusion Parecoxib has significant suppressive effect on patients with postoperative hyperalgesia after remifentanil-based anesthesia.