帕瑞昔布复合舒芬太尼用于胸外科手术术后镇痛的疗效及安全性

Efficacy and safety of sufentanil combined with parecoxib for postoperative analgesia in patients undergoing thoracic surgery

目的评价帕瑞昔布与舒芬太尼合用在胸外科手术术后镇痛的效果及安全性。方法 90例胸外科手术患者,采用前瞻、完全随机、对照方法平均分为3组。常规采用静吸复合麻醉,麻醉诱导和麻醉维持用药相同,手术时间均短于4 h。A组不予帕瑞昔布;B组术前不予帕瑞昔布,术毕静脉注射(静注)帕瑞昔布40 mg;C组术前10 min静注帕瑞昔布40 mg。B、C组分别于首次静注帕瑞昔布后12 h再次静注帕瑞昔布40 mg。3组术后均采用患者自控静脉镇痛法(PCIA),舒芬太尼2.5μg.kg-1+氯化钠注射液100 mL。观察各组镇痛效果、舒芬太尼用量、不良反应等。结果 3组术后镇痛均满意。术后与A组比较,B、C组PCIA按压次数减少,舒芬太尼用量降低(P<0.05)。C组PCIA按压次数和舒芬太尼用量均低于B组(P<0.05)。3组不良反应发生率无显著差异(P>0.05)。结论帕瑞昔布复合舒芬太尼用于胸外科术后镇痛可减少舒芬太尼用量且安全,术前预先静注帕瑞昔布在一定程度上能增强术后镇痛效果。

AIM To evaluate the efficacy and safety of sufentanil combined with parecoxib for post- Operative analgesia in patients undergoing thoracic surgery. METHODS Ninety ASA I - II patients scheduled for thoracic surgery under general anesthesia were randomly assigned to three groups. Patients in the group A were treated without parecoxib. Patients in the group B and C were intravenously injected with parecoxib 40 mg after and before operation, respectively, and were given parecoxib 40 mg once again 12 h after induction. All patients were received patient controlled intravenous analgesia （PCIA） with sufentanil after operation. The analgesic effects were assessed by visual analogue scales （VAS） and the sufentanil consumption at 6 h, 12 h, 24 h and 48 h after operation were investigated. The number of PCIA pressing times was recorded and the adverse reactions were observed. RESULTS Patient satisfaction was excellent in all patients. The sufentanil consumption after operation and the number of PCIA pressing times were significantly lower in the group B and C than those in the group A （P 〈 0.05）. Compared with the group B, the sufentanil consumption after operation and the number of PCIA pressing times were significantly lower in the group C （P 〈 0.05）. There were no significant differences in adverse reactions among the three groups during analgesia. CONCLUSION Sufentanil combined with parecoxib for postoperative analgesia in patients undergoing thoracic surgery is safe and could result in a decrease in the consumption of sufentanil. And preoperative injection of parecoxib may improve postoperative analgesia.