比较两种镇痛药对开胸手术患者全麻苏醒期的影响

Comparison of two kinds of pain-killers on general anesthetic recovery of patients receiving thoracotomy

目的比较镇痛药物帕瑞昔布钠及芬太尼对开胸手术患者全麻苏醒期的影响。方法 178例开胸手术患者随机分为对照组(A组)、芬太尼组(B组)和帕瑞昔布组(C组)。患者以丙泊酚、瑞芬太尼等麻醉诱导及维持。关胸前B组患者给予芬太尼0.1 mg,C组患者给予帕瑞昔布钠40 mg,A组不给镇痛药。记录停麻醉药后5、10、15、20 min患者动脉血压(MAP)、心率(HR)及脑电双频指数(BIS);记录苏醒期躁动的发生及苏醒时间,测定患者入室5 min动脉血氧分压(PaO2)及血氧饱和度(SaO2),记录患者在麻醉恢复室(PACU)驻留时间。结果 (1)停麻醉药后10、15及20 min,B、C组MAP和HR明显低于A组(P<0.05或P<0.01);(2)B组停药后5、10 min的BIS值明显低于A、C两组(P<0.05);(3)B组苏醒时间明显长于A、B组(P<0.05),C组苏醒时间与A组无明显差别;C组PACU驻留时间明显短于A组(P<0.05),B组与A组无显著差异;(4)B、C两组苏醒期躁动发生率明显低于A组(P<0.05);(5)C组SaO2及PaO2明显高于其余两组(P<0.05)。结论镇痛药物帕瑞昔布钠可明显改善开胸手术患者术后通气,缓解循环波动,缩短苏醒时间及PACU驻留时间。

Objective To make comparison of effects between two kinds of pain-killers on general anesthetic recovery of patients receiving thoracotomy. Methods 178 patients received the thoracotomy were randomly divided into control group （ group A, n =55）,fentanyl group （group B, n = 61 ）, and parecoxib sodium group （group C, n = 62）. The patients received the induction of anesthesia and maintenance with propofol and fentanyl, etc. Before the end of the operation, group B received 0.1 mg fentanyl ; group C received 40 mg parecoxib sodium ; and group A did not receive any pain-killers. The mean arterial pressure （ MAP）, heart rate （ HR）, and bispectral index（BIS） were recorded at 5th, 10th, 15th, and 20th minute after cessation of narcotics. The occurrence of agitation in the recovery and recovery time were recorded. The arterial partial pressure of oxygen（ PaO2 ）and oxygen saturation（ SaO2 ）were detected at 5th minute after admission into PACU, and their residence time in PACU was also recorded. Results （ 1 ） MAP and HR in group B and C at 10th,15th, and 20th minute after discontinuation of narcotics were significantly lower than those in group A（P 〈 0.05 and 0.01, respectively）. （2） BIS in group B at 5th and lOth minute after discontinuation was significantly lower than that in group A and C. （3） The recovery time in group B was significantly longer than that in group A （ P 〈 0.05 ）. There was no significant difference in the recovery time between group A and C. The residence time in PACU in group C was significantly shorter than that in group A （ P 〈 0. 05 ）. There was no significant difference between group B and A. （4） The incidence of agitation during anesthetic recovery in group B and C was significantly lower than that in group A （ all P 〈 0.05 ）. （5） PaO2 and SaO2 in group C were significantly higher than those in the other two groups （ all P 〈 0.05 ）. Conclusion Pain-killer parecoxib sodium can significantly improve the postoperative ventilation in patients receiving thoracotomy, ease the volatility of blood circulation, and shortened the recovery time and residence time in PACU.