不同剂量的帕瑞昔布钠用于颅脑手术后镇痛效果的比较

Efficacy of different doses of parecoxib on analgesia after craniotomy:a randomized double-blinded study

目的:随机双盲对比观察不同剂量的帕瑞昔布钠用于颅脑手术后的镇痛效果及不良反应。方法:择期全麻颅脑手术患者90例随机分为帕瑞昔布钠80mg组(Ⅰ组,n=30)、120mg组(Ⅱ组,n=30)和160mg组(Ⅲ组,n=30)。术中吸入七氟烷行全身麻醉。根据分组配置PCA镇痛药物并均以生理盐水稀释到100mL,缝硬膜时接电子止疼泵并开放,设置背景剂量1.5mL/h,单次剂量0.5mL,间隔时间15min。术后患者根据镇痛需求行自控性静脉镇痛(PCIA)。若PCIA仍不能满足患者术后镇痛的需求,再静脉注射布托啡诺或口服去疼片。记录术后清醒时、4h、16～20h、24h、40～44h、48h、64～68h、72h的VAS评分、累计按压次数及累计有效按压次数,观察术后3d内补救用药的使用情况,观察恶心呕吐的程度、球结膜水肿、颜面水肿、皮肤瘙痒、呼吸抑制的发生情况。结果:3组患者术后72h内疼痛的VAS组间比较差异无显著性。Ⅱ组、Ⅲ组患者的PCIA按压次数、有效按压次数低于Ⅰ组(P<0.05)。Ⅲ组患者术后24h内补救用药的使用例数明显少于Ⅰ组,但3d内的总补救例数无差异。3组患者之间术后恶心呕吐的程度、球结膜水肿、颜面水肿、皮肤瘙痒及呼吸抑制的发生无统计学差异。结论:颅脑手术后3d内采用PCA持续泵注帕瑞昔布钠120mg(平均用量1.9mg/h)的镇痛效果较好,量效比最优。

Objective To investigate the efficacy and adverse effects of different doses of parecoxib on analgesia after craniotomy. Methods Ninety ASA physical Ⅰ or Ⅱ neurosurgical patients were randomly allocated into 3 groups to receive low （1.5 mg/h）, middle （1.9 rag/h） or high （2.5 rag/h） doses of paracoxib by intravenously patient controlled analgesia （PCIA, bolus dose 0.05 mL/h, lockout interval 15 minutes, background infusion of 1.5 mL/h）. If PCIA did not provide satisfactory analgesia, butorphanol tartrate 1 mg administered intravenously or compound aminopyrine tablets administered orally as required. VAS （0 = no pain, 10 = the worst pain）, which was used to measure pain intensity, the number of successfully delivered doses, the number of attempt, and the number of redeem medication administration were recorded at awaked and 4 h, 16- 20 h, 24 h, 40- 44 h, 48 h, 64 - 68 h, and 72 h after the operation, respectively. The adverse effects, including nausea, vomiting, pruritus, respiratory depression, facial edema,and conjunctival edema, were observed. Results The number of successfully delivered doses and the number of attempt in group Ⅱ and group Ⅲ were significantly lower than those in group Ⅰ （P 〈 0.05）. The number of redeem medication during the first 24 h after operation was lower in group Ⅲ than that in group Ⅰ . There were no significant differences in adverse effects among the three groups. Conclusion The analgesic efficacy/expense radio of PCA with 120 mg of paracoxib for 3 days （average continuous infusion 1.9 mg/h） should be better.