帕瑞昔布钠不同给药时机对胸科手术病人术后镇痛效果的影响

Effect of different time administration of parecoxib sodium on postoperative analgesic efficacy in patients undergoing thoracic surgery

目的探讨帕瑞昔布钠不同给药时机对胸科手术病人术后镇痛效果的影响。方法采用前瞻性、随机、对照、双盲的研究方法。择期肺叶切除手术病人60例，采用随机数字表法，将病人随机分为3组（n=20），A组切皮前30min和术毕前30min静脉注射生理盐水2ml；B组切皮前30min静脉注射帕瑞昔布钠40mg，术毕前30min静脉注射生理盐水2ml；C组切皮前30min静脉注射生理盐水2ml，术毕前30min静脉注射帕瑞昔布钠40mg。3组术后48h内均行吗啡PCIA，维持VAS评分≤3分。术后随访，记录吗啡用量、病人镇痛满意度评分、体温、胸腔引流量及肝、肾和凝血功能情况，记录恶心、呕吐的发生情况。结果与A组比较，B组和c组吗啡用量减少，病人镇痛满意度评分升高，体温降低（P〈0．05或0．01），B组与c组吗啡用量，镇痛满意度评分和体温比较差异无统计学意义（P〉0．05）。3组间凝血功能指标、肝肾功能指标、胸腔引流量和恶心呕吐发生率比较差异无统计学意义（P〉0．05）。结论切皮前30min与术毕前30min静脉注射帕瑞昔布钠40mg辅助术后镇痛效果相似，均可有效增强胸科手术病人术后吗啡镇痛效果，减少术后发热的发生。

Objective To investigate the effect of different time administration of parecoxib sodium on the postoperative analgesic efficacy in patients undergoing thoracic surgery. Methods This was a prospective, randomized, double-blind, placebo-controlled study. Sixty ASA Ⅰ or Ⅱ patients aged＇17-83 yr undergoing pulmonary lobectomy were randomly allocated to one of 3 groups （ n = 20 each） ： A, B and C groups. Group A received normal saline 2 ml at 30 min before skin incision and the end of operation. Group B received iv parecoxib sodium 40 mg at 30 rain before skin incision and normal saline 2 ml at 30 min before the end of operation. Group C received normal saline 2 ml at 30 min before skin incision and iv parecoxib sodium 40 mg at 30 min before the end of operation. All the patients received patient-controlled intravenous analgesia with morphine and VAS score was maintained ~〈 3. The patients were followed up after operation. The morphine consumption, patients＇ global evaluation of the postoperative analgesia （0-100, 0 = worst pain, Ⅰ（30 = no pain）, nausea and vomiting, body temperature, Volume of chest drainage, hepatic, renal and blood coagulation function were recorded. Results Compared with group A, the morphine consumption was significantly reduced, the patient＇ s satisfaction score increased and body temperature decreased in B and C groups （ P 〈 0.05 or 0.01）. There was no significant difference in the morphine consumption, patient＇ s satisfaction score and body temperature between B and C groups （ P 〉 0.05）. No significant difference was found in the parameters of hepatic, renal and blood coagulation function, volume of chest drainage and incidence of nausea and vomiting among the three groups （ P 〉 0.05 ）. Conclusion When postopera- tive analgesia is assisted with iv parecoxib sodium 40 mg given at 30 min before skin incision or at 30 min before the end of operation, the efficacy is similar, and both can improve the postoperative analgesic efficacy of morphine and reduce fever after operation in patients undergoing thoracic surgery.