帕瑞昔布钠超前镇痛对甲状腺次全切除术后疼痛和应激反应的影响

Effect of Parecoxib Preemptive Analgesia on Postoperative Pain of Subtotal Thyroidectomy and its Stress Response

目的:探讨帕瑞昔布钠超前镇痛对甲状腺次全切除术后镇痛及机体应激反应的影响。方法:选择60例ASAⅠ～Ⅱ级择期在颈丛麻醉下行甲状腺次全切除术的甲状腺腺瘤患者,随机分为超前镇痛Ⅰ组(P1组)、术后镇痛组(PO组)和超前镇痛Ⅱ组(P2组),每组20例。P1组术前10min静脉注射帕瑞昔布钠40mg,PO组术毕10min静脉注射帕瑞昔布钠40mg,P2组术前、后10min静脉注射帕瑞昔布钠20mg。记录术后4h、8h、12h、24h皮质醇(Cor)和血糖(Glu)水平和术后各时点疼痛强度(VAS评分),观察术后24h内不良反应。结果:与PO组比较,P1、P2组血浆Cor和Glu水平明显降低,P<0.05,且P2组比P1组降低明显,P<0.05;镇痛前后差异有显著意义,且T2、T3、T4时显著低于对照组(P<0.05);P1、P2组术后4、8、12、24 h VAS评分明显减少,P<0.05,且P2组比P1组降低明显,P<0.05。3组不良反应差异无显著意义,P>0.05。结论:帕瑞昔布钠超前镇痛有效减轻术后疼痛,抑制术后应激反应,尤以术前、术后结合应用效果最佳。

Objective：To study the pre-emptive analgesia effects of the pareeoxib on postoperative analgesia and Stress response of thyroid gland inferior total excision. Methods： Sixty ASA I-II patients with thyroid adenoma undergoing selective thyroid gland inferior total excision were randomly assigned to three groups（n=20）：group PI（pre-emptive analgesia I）, received parecoxib 40mg 10min before skin cutting;group PO（postoperative analgesia）,received parecoxib 40mg10min after operation;group PII（pre-emptive analgesiall）received parecoxib 20rag 10min before and after operation. The intensity of pain was measured by using a VAS（0-10,0=no pain,10=worst pain）, and recorded at4,8,12,24 h after operation.Venous blood samples were taken at 4,8,12,24 h after operation for detecting cortisol（Cor）and blood glucose（Glu）. The adverse effects were observed within24h.Results： Cor and Glu levels were significantly lowered in groupPl,ll than those in group PO at T2,T3,T4（P〈0.05）,while those in group PII were significantly lowered than those in groupI at the same time（P〈0.05）. Compared with those in group PO,VAS pain scores were significantly decreased in group PI,II at TI, T2, T3, T4,and which were significantly lower in group PII than in group PI.There were no significant different adverse effects in the three groups.Conclusion： Pre-emptive analgesia with parecoxib（especially received parecoxib 20mg 10min before and after operation）could provide effective postoperative pain relief for patients undergoing thyroid gland inferior total excision,and could better inhibit stress on postoperative patients.