帕瑞昔布钠对脊柱融合术后镇痛效果及肾功能的影响

Effects of parecoxib sodium on postoperative analgesia and renal function after spinal fusion surgery

目的观察帕瑞昔布钠对脊柱融合术患者术后镇痛效果及肾功能的影响。方法择期行脊柱融合手术患者60例，ASAⅠ，Ⅱ级，采用随机数字法分为3组，每组20例：A组麻醉诱导时静脉注射帕瑞昔布钠40mg；B组手术结束前10min静脉注射帕瑞昔布钠40mg；对照组C组同时点给予等容量生理盐水静脉注射。术中采用丙泊酚、瑞芬太尼全凭静脉麻醉。所有患者术后接受自控吗啡静脉镇痛。记录拔管后5min，术后2、4、6、12、24、48h静息及咳嗽时的视觉模拟评分（visual analoguescale，VAS）、吗啡消耗量及阿片类相关副作用。观察术中出血量，监测围术期肾功能。结果拔管后5min及术后2h静息与咳嗽状态下的VAS评分，A组（4．4±1．8、2．3±1．1、2．8±1．1）明显低于B组（6．5±1．8、2．8±1．0、3．3±0．9）与C组（7．1±1．9、3．0±1．1、3．6±0．9）（P〈0．05）。术后2h-12h内，A组[（36±27）、（60±44）、（68±51）、（83±57）μg／kg]、B组[（41±18）、（83±47）、（97±52）、（120±9）μg／kg]的吗啡累计消耗量较之C组[（69±36）、（131±61）、（158±79）、（184±84）μg／ks]明显降低（／9〈0．05）。术后24、48h时点A组吗啡累计消耗量较之B组、C组明显减少（P〈0．05）。术后48h内，A、B两组与C组相比，阿片类相关副作用显著降低（P〈0．05）。3组患者术中出血量及围术期肾功能检测无明显改变。结论麻醉诱导前和手术结束时给予帕瑞昔布钠40mg明显减少了术后吗啡的用量和相关副作用，对肾功能无影响。对于脊柱融合术的患者，麻醉诱导时使用帕瑞昔布较之手术结束时使用显示有更好的治疗效果。

Objective To observe the effects of parecoxib sodium on the post-operative pain relief and renal function after spinal fusion surgery. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective decompressive lumbar laminectomy with posterior spinal fusion were randomly divided into group A, B and control group C following intravenous administration of dosing schedule： In group A, parecoxib 40 mg was injected during anesthesia induction; in group B, parecoxib 40 mg was injected 10 min before the completion of surgery; in control group C, the isochoric 0.9% physiological saline was given either at anesthesia induction or 10 min before the completion of surgery. Anesthesia was maintained by propofol and remifentanil. All patients received the patient-controlled intravenous analgesia with morphine after surgery. The scores of visual analog scale （VAS） at rest and during coughing at 5 minutes post-extubation and 2, 4, 6, 12, 24 h and 48 h postoperatively. The total morphine consumption of each time point and the opioid- related symptom distress associated with opioid therapy after surgery were recorded. The red cell loss rate of intraoperative and the renal function in perioperative were measured, respectively. Results The VAS scores of resting and coughing in group A（4.4±1.8, 2.3±1.1, 2.8±1.1）were significantly less than the group B（6.5±1.8, 2.8±1.0, 3.3±0.9） and C（7.1±1.9, 3.0±1.1, 3.6±0.9） at 5 min post-extubation and 2 h after surgery（P〈0.05）. There was no statistically significance of the VAS scores among three groups from 24 h to 48 h after surgery. The total morphine consumption at 2, 4, 6, 12 h were significantly reduced in A[（36±27）, （60±44）, （68± 51）, （83±57）μg/kg] and B[（41±18）, （83±47）, （97±52）, （120±69）Ixg/kg] groups compared with the control group[（69±36）, （131 ±61）, （158 ±79）, （184±84） μg/kg] （P〈0.05）. Summary the morphine consumption at 24 h and 48 h in group A was significantly less than those in groups B and C （P〈0.05）. The opioid-related symptom distresses associated with opioid therapy were less in groups A and B than those in group C within 48 h after surgery. There were no significant differences in the red cell loss rate of intraoperative and the renal function in perioperative among the three groups. Conclusion Intravenous administration of the parecoxib sodium 40 mg either at the onset of anesthesia induction or 10 min before the end of surgery significantly decreased