帕瑞昔布钠对复合瑞芬太尼全麻妇科腹腔镜手术术后急性疼痛和痛觉过敏的影响

Effect of parecoxib sodium used at different time points on acute postoperative pain and hyperalgesia of patients with gynecological laparoscopic operation under remifentanil -based combined anesthesia

目的观察不同时点给予帕瑞昔布钠对复合瑞芬太尼全麻的妇科腹腔镜手术患者术后急性疼痛及痛觉过敏的影响。方法60例ASAI～Ⅱ级患者随机分为3组：帕瑞昔布钠术前给药组（A组）、帕瑞昔布钠术后给药组（B组）、芬太尼术后给药组（C组）。记录患者入室时（Ta）、术毕停药5min后（Tb）及拔管后即刻（Tc）的平均动脉压（MAP）和心率（HR），记录拔管后1min（T1）、拔管后30min（T2）、拔管后1h（T3）、拔管后2h（T4）的口述分级法（VRS）痛觉评分，并记录患者睁眼、拔管时间及行镇痛补救措施和不良反应的例数。结果3组患者Tb、Tc的MAP、HR均较Ta高，尤以B组为著（P〈0．05）。C组睁眼时间和拔管时间均明显较A组和B组延长。VRS痛觉评分：T1时点B组较A组、C组高（P〈0．05），T4时点C组较A组、B组高（P〈0．05）。镇痛补救措施的例数：T0（麻醉复苏期间拔管前）、T1时点：B组较A组和C组多（P〈0．05）；T4时点：C组较A组和B组多（P〈0．05）。B组术后躁动的发生率较A组和C组高（P〈0．05），C组术后呼吸抑制和恶心呕吐的发生率较A组和B组高（P〈0．05）。结论术前使用帕瑞昔布钠40mg可有效缓解复合瑞芬太尼全麻的妇科腹腔镜手术术后急性疼痛及瑞芬太尼引起的痛觉过敏。

Objective To observe the effect of parecoxib sodium used at different time points on acute postoperative pain and hyperalgesia of patients with gynecological laparoscopic operation under remifentanil - based combined anesthesia. Methods Sixty patients of ASA I - II were randomly divided into three groups： group A （paracoxib sodium was intravenously injected at the beginiug of surgery） , group B （paracoxib sodium was intravenously injected at the end of surgery） and group C （fentanil was intravenously injected at the end of surgery）. The mean arterial pressure （MAP） and heart rate （I-IR） were recorded before injection （Ta ） , 5 rain after cessation of injection （Tb ） and immediately after extubation （Te）. Pain rates was evaluated by VRS at 1 rain （T1 ）, 30 min （T2）,1 h （T3）,2 h （T4） after extubation, and the time to awakening, the time to extubation, the number of patients who used analgesia and the number of adverse effects were recorded. Results The MAP and HR of all groups at Tb and To were significantly higher than those at Ta, especially for group B （ P 〈 0.05 ）. The time of awakening and extubation in group C were significantly longer than those in group A and B （P〈0.05）. The results of VRS in group B at T1 were higher than those in group A and C （P 〈 0.05 ） ; The results of VRS in group C at T4 were higher than those in group A and B （ P 〈 0.05 ）. The number of patients who used analgesia in group B at TO （ anesthesia recovery period before drawing tube ） and T1 were more than those in group A and C （ P 〈 0.05 ） ; the number in group C at T4 were more than those in group A and B （ P 〈 0.05 ） ; The rates of agitation in group B was higher than those in group A and C （ P 〈 0.05 ）, the rates of postoperative respiratory depression and nausea and vomiting in group C were higher than those in group A and B （ P 〈 0.05）. Conclusion Preop- erative using of parecoxib sodium 40 mg can relieve acute postoperative pain and hyperalgesia of patients with gynecological laparoseopic operation under remifentanil - based combined anesthesia.