帕瑞昔布钠加入多模式镇痛对胸腔镜辅助开胸术后吗啡用量的影响

Effects of parecoxib on morphine dosage in postoperative patient-controlled analgesia following thoracoscope-assisted thoracotomy

目的观察帕瑞昔布钠对胸腔镜辅助开胸术镇痛效果和术后吗啡静脉自控镇痛(PCA)用量的影响。方法选择胸腔镜辅助开胸手术患者100例,随机分为5组(P1,P2,P3,P4,P5组),每组20例,行双盲对照观察。5组病人均在切皮前给予帕瑞昔布钠40 mg静脉注射,关胸前胸腔内肋间神经阻滞以切口为中心上下三个肋间注射利罗合剂4～5 ml,术后5组均给予吗啡静脉PCA泵。P1组为对照组(生理盐水200 ml);P2组(吗啡5 mg+生理盐水=200 ml);P3组(吗啡10 mg+生理盐水=200 ml);P4组(吗啡15 mg+生理盐水=200 ml);P5组(吗啡20 mg+生理盐水=200 ml)。术后每24 h静脉注射帕瑞昔布钠40 mg。观察:静息、咳嗽视觉模拟评分(VAS);患者呼吸功能评价(RR、SpO2、EtCO2、VT)。记录PCA泵开启后1、2、4、8、12、24、36、48 h时点上述各项指标,在各时段内记录PCA泵的实际按压次数(D1)及有效按压次数(D2)。结果 5组患者在术后24 h内均无呼吸抑制,在术后0～6 h静息VAS评分无显著性差异;P1组的8～24 h静息、咳嗽VAS评分明显高于P2、P3、P4、P5组(P<0.05),P2、P3、P4、P5组间比较无显著性差异(P>0.05);36～48 h各组静息、咳嗽VAS评分无显著差异。P1、P2组的D1/D2在4～24 h与其他各组比较有显著性差异(P<0.05),P3～P5组之间无显著性差异。结论帕瑞昔布钠加入胸腔镜辅助开胸术后多模式镇痛,可以减少吗啡用量,镇痛效果良好,对开胸手术病人呼吸影响小,有利于病人排痰。

Objective To observe the effect of parecoxib on morphine dosage in patient-controlled analgesia（PCA） following thoracoscope-assisted thoracotomy.Methods A consecutive series of 100 patients undergoing thoracoscope-assisted thoracotomy were randomized into 5 groups and received PCA with morphine doses at 0,5,10,15,and 20 mg given in 200 ml saline（groups P1,P2,P3,P4,and P5,respectively）.Parecoxib（40 mg） was given in all the patients immediately before the operation,and the mixture（4-5 ml） of lidocaine and ropivacaine was administered into the 3 intercostal spaces upper and lower to the incision before chest closure.PCA was administered for each patient.The visual analogue scale（VAS） at rest and coughing and the respiratory functional parameters were recorded at 1,2,4,8,12,24,36,and 48 h after the start of PCA,and the actual and effective button-pressing times（D1/D2） in PCA were also recorded.Results No patients showed signs of respiratory inhibition within 24 h after the operation,and the resting VAS was comparable between the groups within the initial 6 postoperative hours.At 8 to 24 h postoperatively,the VAS scores at rest and coughing were significantly higher in P1 group than in the other groups（P0.05）,and no significant differences were found between the groups at 36 to 48 h.D1/D2 in groups P1 and P2 were significantly different from those in the other 3 groups at 4-24 h,but no such difference was found between groups P3,P4,and P5.Conclusion The application of parecoxib may reduce the dosage of morphine in PCA following thoracoscope-assisted thoracotomy and results in good analgesic effect without affecting the patients＇ respiratory function and sputum elimination.