帕瑞昔布钠-舒芬太尼用于开胸术后患者静脉镇痛对凝血功能影响

Effect of Parecoxib Sodium-Sufentanil for patient-controlled intravenous analgesia and impact on blood coagulation in patients with thoracic surgery

目的通过观察帕瑞昔布钠-舒芬太尼用于开胸术后患者静脉自控镇痛效果及对患者凝血功能的影响,探讨适合开胸手术患者术后的镇痛方法。方法选择择期行开胸术患者60例随机分组:Ⅰ组对照组(舒芬太尼2μg/kg);Ⅱ组术后镇痛组(术毕前20min静注帕瑞昔布钠40mg,舒芬太尼1μg/kg);Ⅲ组超前镇痛组(麻醉诱导时静注帕瑞昔布钠40mg,舒芬太尼1μg/kg)。于术前30min、术后1h、24h、48h检测患者血浆去甲肾上腺素、促肾上腺皮质激素、皮质醇及血小板计数、凝血酶原时间、激活部分凝血酶原时间、纤维蛋白原。结果两实验组患者术后VAS评分显著降低。3组患者不同时点PLT、PT、APTT、FB组内及组间无统计学差异(P>0.05)。术后2天PCIA有效自控次数Ⅱ组、Ⅲ组均少于Ⅰ组(P<0.05),且Ⅱ组低于Ⅲ组P<0.05)。结论帕瑞昔布钠-舒芬太尼患者静脉自控镇痛的镇痛效果确切,对患者凝血功能影响不明显,可减少阿片类药物用量。

Objective To observe the effect of Parecoxib Sodium-Sufentanil in thoracic surgery patient of postoperation patient-controlled intravenous analgesia and its effect on blood coagulation,for exploring proper methods of postoperative analgesia.Methods Totally 60 patients with thoracic surgery were randomly divided into three groups： group Ⅰ（sufentanil 2 μg/kg）;group Ⅱ（Parecoxib Sodium 40 mg postoperative intravenous intravenous,sufentanil 1 μg/kg）;group Ⅲ（Parecoxib Sodium 40 mg preoperative intravenous analgesia,sufentanil 1 μg/kg）.Respectively,before surgery 30 min,after 1h,24d,48h collected patients＇ venous plasma for the test of norepinephrine（NE）,adrenocorticotropic hormone（ACTH）,cortisol（COS） and platelet count（PLT）,prothrombin time（PT）,activated partial thromboplastin time（APTT） and fibrinogen（FB）.Results The M-VAS scores at 6h,24h,48h in Parecoxib sodium groups were significantly lower than that in control group（P0.05）.PLT,PT,APTT,FB of three groups patients at different points and between the three groups were no significant difference（P0.05）.After surgery 2 days,the number of PCIA effective self-control in group Ⅱ,Ⅲ was less than group Ⅰ（P0.05）.Conclusions Postoperation of thoracic surgery patients using parecoxib sodium-sufentanil analgesia has little impact on coagulation function,can reduce the dose of opioid.