帕瑞昔布钠对老年患者腹腔镜胆囊切除术超前镇痛作用的观察

Effect of preemptive analgesia with parecoxib sodiumon in elderly patients undergoing laparoscopic cholecystectomy

目的观察帕瑞昔布钠用于老年患者腹腔镜胆囊切除术的超前镇痛效应及对应激反应的影响。方法择期行腹腔镜胆囊切除术的患者40例，完全随机等分成2组，麻醉诱导前30min，研究组静脉注射帕瑞昔布钠40mg，对照组静脉注射0．9％氯化钠注射液2ml。分别于麻醉诱导前30min（T0）、手术结束时（T1）、术后2h（T2）、术后24h（T3）各采静脉血3ml，采用放射免疫法测定血皮质醇及P物质浓度。记录T1、T2、T3时的10cm视觉模拟评分法（VAS）评分。结果2组Ti、T2、T3时的血浆皮质醇水平均明显高于Tn时点[研究组分别为（444±123）、（532±128）、（796±186）nmol／L比（342±136）nmol／L，对照组分别为（821±187）、（913±194）、（1036±249）nmol／L比（356±152）nmol／L]，而研究组T1、L、L时的血浆皮质醇水平均明显低于对照组（均P〈0．05）；对照组T1、T2、T3时血清P物质浓度则明显高于T。时点[分别为（139±10）、（147±11）、（139±11）ng／L比（91±9）ng／L，均P〈0．05]，研究组T1、T2、T3各时点的血清P物质浓度与Tn时点的差异均无统计学意义[分别为（103±9）、（111±11）、（118±11）ng／L比（90±8）ng／L，均P〉0．05]，研究组T1、T2、L时VAS评分均明显低于对照组[分别为（1．8±0．6）分比（6．9±1．2）分、（1．2±0．4）分比（4．2±0．9）分、（1．6±0．6）分比（3．3±0．7）分，均P〈0．05]。结论帕瑞昔布钠能安全用于老年腹腔镜胆囊切除术患者，可有效抑制患者的应激反应，产生良好的超前镇痛效应。

Objective To investigate the effects of parecoxib sodium on preemptive analgesia and the stress response in elderly patients undergoing laparoscopic cholecystectomy. Methods Totally 40 patients undergoing elective laparoscopic cholecystectomy were randomly divided into two groups： the study group received intravenous parecoxib sodium 40 mg 30 minutes before anesthesia induction, and the control group received normal saline 2 ml instead of parecoxib. Venous blood samples were obtained at 30 minutes before anesthesia induction （ T0 ）, at the end of surgery （ T1 ）, and 2 hours （ T2 ） ,24 hours （ T3 ） after the surgery was finished, to determine the plasma levels of serum cortisol and substance P by radioimmunoassay. Visual analogue scale （VAS） scores were recorded at T, ,T2 and T3. Results In the two groups, plasma levels of serum cortisol at T1 ,T2 and T3 were significantly higher than those at TO [ study group was （444 ± 123 ）, （532± 128 ）, （796 ±186） nmol/L vs （ 342± 136） nmol/L; control group was（821 ±187）, （913 ±194）, （1036 ±249） nmol/L vs （356 ± 152） nmol/L,respectively] （P 〈 0. 05）. In the study group, plasma levels of serum cortisol at T1 ,T2 and T3 were significantly lower than those in the control group （P 〈0. 05）. In the control group the plasma levels of substance P at T1 ,T2 and T3 [ （ 139 ± 10）, （ 147 ± 11 ）, （ 139 ± 11 ） ng/L ] were significantly higher than those at TO [ （91 ± 9 ） ng/L ] （ P 〈 0.05 ）. But in the study group the plasma levels of substance P at T1, T2 and T3 [ （ 103± 9 ）, （ 111± 11 ）, （ 118 ±11 ） ng/L ] were not statistically different compared to those at To[ （90 ±8）ng/L] （P 〉0.05）. In the study group VAS scores at T1 ,T2 and T3 were significantly lower than those in the control group at each time point （ P 〈 0. 05 ）. Conduslons Parecoxib sodium can be safely used in elderly patients undergoing laparoscopic cholecystectomy. It can inhibit the stress response effectively and produce preemptive analgesia effect.