帕瑞昔布钠超前镇痛对乳癌根治术后静脉镇痛的影响

The preemptive analgesia of parecoxib sodium on postoperative pain after breast cancer surgery

目的探讨帕瑞昔布钠超前镇痛对乳癌根治术后静脉镇痛的影响。方法择期行乳腺癌根治术的患者60例,随机等分成两组,Ⅰ组麻醉诱导前5 min静脉注射帕瑞昔布钠40 mg,Ⅱ组静脉注射生理盐水2 ml。分别于麻醉诱导前10 min(T0)、手术结束时(T1)、术后4 h(T2)和术后24 h(T3)采用放免法测定血浆6-酮前列腺素1(6-Keto-PGF1)浓度。两组患者均采用静脉病人自控镇痛(PCA)镇痛泵(吗啡1 mg/ml,氯胺酮1 mg/ml;PCA每次1 ml,有效按压时间5 min/次),并在术后4 h、12 h、24 h记录镇痛泵按压次数。观察患者是否有头晕、恶心、呕吐及呼吸抑制等不良反应,并进行镇痛效果评价(VAS评分)。结果与T0比较,两组T1、T2、T3各时点的血浆6-Keto-PGF1水平均明显升高,而Ⅰ组T1、T2、T3各时点的血浆6-Keto-PGF1水平均明显低于Ⅱ组相同时点(P<0.05);Ⅰ术后4 h、12 h、24 h的VAS评分及静脉镇痛泵按压次数明显低于Ⅱ组(P<0.05)。结论帕瑞昔布钠能具有良好的超前镇痛效应,能安全用于乳腺手术患者。

Objective To explore the preemptive analgesia of parecoxib sodium on breast cancer surgery.Methods Sixty patients undergoing breast cancer surgery were randomly divided into groups of receiving intravenous parecoxib sodium 40 mg at 5min before the induction of anesthesia（groupⅠ） or normal saline 2 ml（group Ⅱ）.The level of plasma 6-Keto-PGF1 was measured by radioimmunoassay at 10 minutes before the anesthesia induction（T0）,the end of surgery（T1）,postoperative 4 h（T2）,and 24 h（T3）.Patient controlled analgesia（PCA） pump containing 1mg/ml morphine and ketamine was intravenously used for postoperative analgesia in patients of both groups.The setting of PCA pump was a bolus of 1ml for one demand and 5 minutes for one locking time.Visual analogue scale（VAS） and the demands for PCA were recorded at postoperative 4 h,12 h,and 24 h.Side effects such as dizziness,nausea,vomiting,and respiratory depression were observed.Results The level of plasma 6-Keto-PGF1 was higher at T1,T2,and T3 than that at T0 in both groups（P〈0.05）,and the level of plasma 6-Keto-PGF1 in group Ⅱ was higher than that in group Ⅰat the same time point（P〈0.05）.VAS and the demands for PCA in group Ⅱ were higher than those in groupⅠ（P〈0.05）.Conclusion Parecoxib sodium has good preemptive analgesic effect and is safe for patients after breast cancer surgery.