帕瑞昔布钠不同时段给药对腰椎手术后镇痛及血流动力学的影响

The Postoperative Analgesia and Hemodynamics Influence of Parecoxib Administered at Different Times on General Anesthesia Lumbar Canal Operation

目的 观察帕瑞昔布钠不同时段给药对腰椎管手术术后镇痛及血流动力学的影响.方法 60例ASAⅠ或Ⅱ级全麻下行下腰椎手术的患者随机分为A,B,C,D 4组,A组全麻诱导前静注帕瑞昔布钠40mg（稀释为5ml）;B组术中静注帕瑞昔布钠40mg（稀释为5ml）;C组术后静注帕瑞昔布钠40mg（稀释为5ml）;D组为对照组.4组患者于缝皮时开启静脉自控镇痛（PCIA）泵（100ml溶液含舒芬太尼100μg）.记录苏醒后即刻（T1）、术后4h（T2）、24h（T3）、48h（T4）的VAS评分,记录术后4h 及24h内PCIA泵按压次数,术后24h舒芬太尼用量以及围手术期48h的血流动力学变化,观察头晕、恶心呕吐发生率.结果 T1～T4时A,B,C组的VAS评分均显著低于D组;T1,T2时A,B组VAS评分显著低于C组.A,B,C组术后24h PCIA泵按压次数、舒芬太尼用量及术后恶心呕吐发生率显著低于D组.静注帕瑞昔布钠对患者术中、术后的血压无影响.结论 腰椎管全麻手术中使用帕瑞昔布钠有良好镇痛作用及超前应用时能明显降低舒芬太尼的用量,而且对血流动力学无影响,安全可靠.

Objective To investigate the postoperative analgesia and hemodynamics influence of parecoxib administered at different times on general anesthesia lumbar canal operation. Methods Sixty patients, ASA I or lI, undergoing lumbar canal operation under general anesthesia were randomly divided into A, B, C, D four groups, group A ：40mg （ diluted to 5 ml ） parecoxib before anesthesia induction, B ：40rag（ diluted to 5m l） parecoxib intravenous injection on the surgery, C ：40rag（diluted to 5m l） parecoxib intravenous injection after the surgery, D： the control group. All patients received patientcontrolled intravenous analgesia （ PCIA, containing fentany 100p4g diluted to 100ml ） at the end of the surgery. Visual analog score（VAS） was recorded to evaluate pest-operative pain at the time of analepsia（ T1 ） ,and 4h（ T2 ）, 24h { T3 } and 48h （ T4 ） after the surgery. PCIA button press times 4h and 24h after the surgery, total fentanyl usage 24h after the surgery, changes in blood pressure of perioperative 48h, and the incidence of dizziness, nausea and vomiting were also recorded. Results The VAS score at T1 -T4 were significantly lower in group A,B and C than those in group D;and the VAS score at Tl ,T2 were significantly lower in group A and B than those in group C. PICA button press times and total fentanyl usage 24 hours after surgery and the incidence of pest-operative nausea and vomiting were lower in group A, B and C than those in group D. Intravenous parecoxib had no effect to patients＇blood pressure in and after the surgery. Conclusion Parecoxib can provide good analgesia on general anesthesia lumbar canal operation and it has a preemptive analgesic effect,and also hase no effect on blood pressure,safe and reliable.