帕瑞昔布悬雍垂腭咽成行术后的延迟气管拔管

Enhancing effect of parecoxib in delay endotracheal extubation after uvulopalatopharyngoplasty

目的探讨帕瑞昔布能否减轻悬雍垂腭咽成行术后延迟气管拔管的相关并发症。方法选择因阻塞性睡眠呼吸暂停综合征(OSAHS)择期行悬雍垂腭咽成形术患者40例,ASAⅡ～Ⅲ级,将患者随机分为帕瑞昔布组(P组,n=20)和对照组(C组,n=20)。全麻插管后分别静脉注射帕瑞昔布40mg(P组)和相同容量的生理盐水(C组),记录手术时间、麻醉时间、手术结束至呼吸恢复的时间(T1)、呼吸恢复至苏醒的时间(T2)、苏醒后患者对气管导管的耐受情况,并记录患者苏醒后至气管导管拔除的时间(耐管时间T3),记录T1、T2、T3的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),同时评估患者苏醒期间的躁动评分。记录两组患者手术结束至气管导管拔除时间。结果两组患者的手术时间、麻醉时间、T1、T2差异均无统计学意义;P组T3明显长于C组(P<0.01);手术结束后T1、T2、T3及拔除气管导管时的MAPP组明显较C组平稳(P<0.01),两组患者手术结束后至气管导管拔除时间P组明显长于C组。P组躁动评分明显优于C组(P<0.01)。结论术前静脉注射帕瑞昔布40mg能提高悬雍垂腭咽成形术患者术后对气管导管的耐受程度,有效预防术后躁动,延迟气管导管拔管。

Objective To investigate the enhancing effect of parecoxib in delay endotmcheal extubation after （UPPP）. Methods Forty patients diagnosed with obstructive sleep apnea syndrome （OSAHS） of ASA Ⅱ～Ⅲ scheduled for UPPP were allocated into two groups： the study group （group P, treated with 40 mg parecoxib intravenously after endotracheal intubation） and the control group （Group C, treated with 20 ml 0.9% NS instead of parecoxib）. The duration of surgery （DS）, duration of anesthesia （DA）, the interval from the ending of surgery to the re- covery of spontaneous ventilation （TO, the interval from recovery of spontaneous ventilation to the recovery of conscious （T2）, and interval from the recovery of conscious to endotracheal extubation （T3） were recoded. The mean arterial blood pressure （MAP）, heart rate （HR）, pulse oxirnetry （SpO2） during T1, T2 and T3 were also collected, and the status of restless- ness was assessed in all the patients. Results There were no statistically significant difference between the two groups in DS, DA, T1 and T2. T3 was significantly longer in group p than that group C （P〈0.01）. The MAP during T1, T2and T3 and at endotracheal extubation were significantly more stable in group P than group C （P〈0.01）. The scale of restlessness in group P was significantly lower than that in group C （P〈0.01）. Conclusion Intravenous injection with 40 mg parecoxib before surgery can enhance the patients＇ tolerance to endotracheal tube, resulting in the delay of extubation and less restlessness.