帕瑞昔布钠对骨科患者术后舒芬太尼静脉镇痛效果的影响

Effect of parecoxib on efficacy of postoperative analgesia in patients undergoing orthopedic surgery

目的观察帕瑞昔布钠对骨科患者术后舒芬太尼静脉镇痛效果的影响。方法全麻下行骨科手术的患者90例,ASAⅠ或Ⅱ级,随机平均分为3组:对照组(C组)、帕瑞昔布钠20 mg组(P1组)、帕瑞昔布钠40 mg组(P2组),采用咪唑安定—依托咪酯—舒芬太尼—罗库溴铵全麻诱导,七氟醚—舒芬太尼—顺式阿曲库铵维持。手术结束后采用舒芬太尼2μg/kg行患者静脉自控镇痛(PCIA)。分别于术后1(T1)、4(T2)、8(T3)、12(T4)、24(T5)、48 h(T6)时,采用视觉模拟评分(VAS)评分评价患者疼痛程度;记录上述各时间点患者自控镇痛(PCA)总次数、总有效次数;上述各时间点舒芬太尼用量;并记录术后48 h内恶心、呕吐、皮肤瘙痒、呼吸抑制和循环抑制的发生情况。结果与C组相比,P1组T2、T3时VAS评分降低,P2组T2～T6时VAS评分降低(P<0.05),P1组T2、T3时患者PCA总次数、总有效次数减少,P2组T2～T6时PCA总次数、总有效次数减少(P<0.05),P1组T2、T3时舒芬太尼用量减少,P2组T2～T6舒芬太尼用量减少(P<0.05)。与P1组比较,P2组T2-T6时VAS评分降低(P<0.05),T2～T6时患者PCA总次数、总有效次数减少(P<0.05),T2～T6舒芬太尼用量减少(P<0.05)。P2组较C组和P1组恶心、呕吐发生例数减少(P<0.05)。结论切皮前静脉给予帕瑞昔布钠40 mg能明显减少术后舒芬太尼的用量,术后镇痛效果满意。

Objective To investigate the effect of intravenous injection of parecoxib on the postoperative sufentanil analgesia in orthopedic patients.Methods Ninety ASA Ⅰ-Ⅱpatients undergoing orthopedic surgery were randomly divided into 3 groups（n = 30） ： At 20 min before skin incision the patients in group C received intravenous injection of normal saline 2 ml,and those intravenous injection of parecoxib（20 mg） were group P1,parecoxib（40 mg） was injected in group P2.Anesthesia was induced with midazolam,etomidate,sufentanil,rocuronium.Anesthesia was maintained with sevoflurane,cisatracurium sufentanyl.After operation,the patients in three groups received patientcontrolled intravenous analgesia（PCIA） with sufentanil.A blinded observer recorded the time of awaking,consciousness and extubating,the VRS 5 min after consciousness.The sufentanil consumption,the number of unsatisfied demand and the number of successfully delivered dose,the VAS,the side effects were recorded at 1,4,8,12,24 and 48 h after operation.Results Compared with group C,the consumption of sufentanil was significantly decreased at T2,T3 in group P1 and at T2 ～ T6 in group P2（P 0.05）,the VAS score was significantly decreased at T2,T3 in group P1 and at T2 ～ T6 in group P2（P 0.05）,the number of total demand and successfully delivered doses were decreased at T2,T3 in group P1 and at T2 ～ T6 in group P2（P 0.05）.Compared with group P1,the VAS score was significantly decreased at T2 ～ T6 in group P2（P 0.05）,the number of total demand and successfully delivered doses were decreased at T2 ～ T6 in group P2（P 0.05）.The occurrence of nausea and vomit was significantly decreased in group P2 compared with those in group P1 and C.Conclusion Intravenous injection of parecoxib 40 mg before operation can reduce the postoperative sufentanll consumption in orthopedic patients.