帕瑞昔布钠对应用曲马朵患者自控静脉镇痛效果的影响

Effect of parecoxib sodium on patient-controlled intravenous analgesia with tramadol

目的观察帕瑞昔布钠对应用曲马朵患者自控静脉镇痛(PCIA)效果的影响。方法行择期经腹全子宫切除术患者40例随机分为2组,PCIA负荷量观察组给予帕瑞昔布钠40 mg和曲马朵2 mg.kg-1,对照组给予曲马朵2 mg.kg-1,PCIA泵内含12 mg.kg-1曲马朵、托烷司琼5 mg、9.0 g.L-1氯化钠100 mL。观察比较2组麻醉前(T1)、回病房后1(T2)、2(T3)、4(T4)、8(T5)、12(T6)、24(T7)、36 h(T8)的心率(HR)、平均动脉压(MAP)以及T2～T8时点视觉模拟评分(VAS)和镇静评分(SS)及恶心呕吐的发生率。结果对照组T2～T4时点HR、MAP和VAS高于其他时点,且高于观察组同时点,差异均有统计学意义(P<0.05);观察组内各时点HR和MAP比较差异无统计学意义(P>0.05),T2～T4时点VAS评分均低于T5～T8时点(P<0.05)。对照组和观察组T2、T3时点SS均高于T4～T8时点(P<0.05),观察组T2、T3时点SS高于对照组,差异有统计学意义(P<0.05)。2组患者术后均未发生呕吐,术后恶心发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠可提高曲马朵PCIA早期镇痛质量,使患者术后血流动力学更平稳。

Objective To observe the effects of parecoxib sodium on patient-controlled intravenous analgesia （PCIA） with tramadol. Methods Forty patients who underwent total abdominal hysterectomy were selected and randomly divided into control group and observation group. The loading dose of PCIA was intravenous injection of parecoxib sodium 40 mg and tramadol （2mg·kg^-1）in observation group and tramadol（ 2 mg·kg^-1 ）in control group. The PCIA bump was filled with tramadol （ 12mg·kg^-1） ,tropisetron 5 mg and 9.0 g·L^-1 NaCl of 100 mL. The heart rate（HR） ,mean arterial pressure（MAP） ,visual analogue score （ VAS）, sedation score （SS） at T2 - Ts and incidence of nausea and vomitting were compared between the two groups before anesthesia （ T1 ）, at 1 hour （ T2 ）, 2 （ T3 ） ,4 （ T4 ）, 8 （ T5 ）, 12 （ T6 ） , 24 （ T7 ）, 36 hours （ Ts ） after operation. Results The HR, MAP and VAS at T2 - T4 were significantly higher than those at other time points in control group and were signifi- cantly higher than the same time point in observation group （P 〈 0.05 ）. There were not statistic difference of HR and MAP at the different time point（P 〉0.05）,but the VAS at T2 -T4 were obviously lower than those at T5 -Ts in observation group （ P 〈 0. 05 ）. The SS at T2 , T3 were higher than those at T4 - Ts in the two groups （ P 〈 0.05 ）. The SS at T2 and T3 in the obser- vation group was significantly higher than that in the control group（ P 〈 0.05 ）. The patients had no nausea and vomiting symptom after operation in the two groups, the rates of nausea and vomiting were no significant difference（ P 〉 0.05 ）. Conclusion Parecoxib sodium can improve the analgesic quality of tramadol used for PCIA in early period and maintain stable hemodynam- ics of patients after postoperative patients.