帕瑞昔布钠与芬太尼对预防雷米芬太尼静脉全麻苏醒期躁动的比较

Comparison of Celebrex Sodium and Fentanyl Parry on Prevention of Restlessness in the Stage of Analepsia after Intravenous Anesthesia with Remifentanil

目的探讨和比较帕瑞昔布钠与芬太尼在预防妇科腹腔镜手术雷米芬太尼复合丙泊酚静脉全麻苏醒期躁动的有效性和安全性。方法择期妇科腹腔镜手术患者150例,ASAⅠ～Ⅱ级,随机分为A、B、C三组,每组50例。三组麻醉方案相同,A组(n=50)全麻诱导前20 min静注帕瑞昔布钠40 mg;B组(n=50)术毕前20 min静注芬太尼1μg/kg;C组(n=50)术毕前20 min静注生理盐水10 ml,记录术毕至拔管所用时间、拔管期间不良事件,评定苏醒躁动程度(RS)、拔管后疼痛程度(VAS)和镇静程度(RASS)。结果 A、B组苏醒期RS评分及VAS评分均显著低于C组(P<0.05),RASS评分显著高于C组,(P<0.05),A、B组无统计学差异。与A、C组比较,B组患者自主呼吸恢复时间、意识恢复时间及拔管时间有所延长,差异有统计学意义(P<0.05)。结论超前应用帕瑞昔布钠可有效预防雷米芬太尼复合丙泊酚全麻中苏醒期躁动的发生,其效果与芬太尼比较无统计学差异,同时减少因使用阿片类镇痛药而发生的恶心、呕吐、苏醒延迟、呼吸抑制等副作用。

Objective To investigate and compare the efficiency and safty of celebrex sodium and fentanyl parry on prevention of restlessness in the stage of analepsia after intravenous anesthesia with remifentanil and propofol in gynaecological laparoscopic surgery.Methods 150 patients who volunteered to receive gynaecological laparoscopic operation（ASAⅠ~Ⅱ）,were randomly divided into group A,group B and group C（n = 50）,and all of the patients who anticipated this study were given the same anaesthesia technique.20 min before induction of general anaesthesia,patients in group A were given intravenous injection of parecoxib sodium 40 mg;20 min before the end of the surgery,patients in group B were given intravenous injection of fentanyl 1 μg/kg;20 min before the end of the operation,patients in group C were given intravenous injection physiological saline 10 ml.The following items were observed and recorded： the time needed from the end of the operation to pipe drawing and the harmful incidents in stage of analepsia,which would assessed by RS,VAS and RASS scores.Results RS and VAS scores of patients in group A and B were significantly lower than those in group C（P 0.05）,RASS scores of patients in group A and B were significantly higher than those in group C,A and B group had no significant difference.Recovery time of spontaneous breathing,consciousness recovery time and the time for pipe drawing of patients in group B were significantly longer than those in group A and group B（P 0.05）.Conclusion Advanced administration of parecoxib sodium can efficiently prevent the occurrence of restlessness after intravenous anesthesia with remifentanil,which can reduce the incidence of nausea,vomiting,palinesthesia delay and respiratory depression as using opioid analgesics,with insignificant difference compared with fentanyl.