帕瑞昔布钠在腹腔镜结直肠癌根治术后的镇痛作用

Application of Parecoxib on Postoperative Analgesia for Laparoscopic Colorectomy

目的观察帕瑞昔布钠联合静脉自控镇痛(PCA)用于腹腔镜结直肠癌根治术术后镇痛的有效性和安全性。方法择期腹腔镜结直肠癌根治术患者90例,随机分为A、B、C组,各30例。A组手术结束前30min静脉注射帕瑞昔布钠40mg,术后12,24h静脉注射0.9%氯化钠注射液10mL;B组在上述3个时间点均静脉滴注帕瑞昔布钠40mg;C组在上述3个时间点均给予0.9%氯化钠注射液10mL,所有患者接受PCA。记录术后12,24,36,48h的视觉疼痛模拟(VAS)评分,0～12h、～24h、～48h镇痛泵有效按压次数和芬太尼用量,首次肛门排气、排大便时间。结果 3组手术后VAS评分差异无显著性(P>0.05);B组镇痛泵有效按压次数和芬太尼用量均显著低于A组和C组(均P<0.05);B组首次肛门排气、排大便时间早于A组和C组(均P<0.05)。结论腹腔镜结直肠癌根治术采用帕瑞昔布钠重复给药联合芬太尼PCA镇痛,效果明确,芬太尼用量降低,胃肠功能恢复快。

Objective To study the efficiency and safety of parecoxib combined with patient controlled intravenous analgesia（PCA）for laparoscopic colorectomy.Methods 90 patients under laparoscopic colorectomy were randomly divided into 3 groups,group A（i.v.40 mg parecoxib 30 min before the end of operation and 10 mL N.S.instead 12 h and 24 h after operation）,B（only with 40 mg parecoxib）andC（only with N.S.）.All patients received 3 injections with different recipes,but PCA.The effective pump bolus times and total fentanil consumed dosage,VAS score（12,24,36,48 h postoperation）,time of first flatus and first defecation,Ramsay score and PONV（at 0～12 h,～24 h,～48 h）were recorded.Results There were no statistical difference in VAS score among three groups（P0.05）.Times of effective pump bolus and fentanil consumed dosage in group B were lower and time of first flatus and first defecation was earlier compared with those in group A and C（P0.05）.Conclusion Multiple injection of parecoxib has a good postoperative analgesic effect,reduces the fentanil consumption and accelerates the gastrointestinal recovery.