帕瑞昔布钠对腹腔镜辅助下胃癌手术患者血浆前列腺素E2水平及术后患者自控镇痛效果的影响

Effects of parecoxib sodium on plasm concentration of prostaglandin E2 and patient-controlled analegsia in patients after laparoscopic gastrectomy

目的 观察帕瑞昔布钠对腹腔镜辅助下胃癌手术患者血浆前列腺素E2（PGE2）水平及术后患者自控镇痛（PCA）临床效果的影响.方法 选择接受术后静脉患者自控镇痛（PCIA）的腹腔镜辅助胃癌手术患者90例,随机分为对照组（S组）和帕瑞昔布钠组（P组）,各45例.S组分别于手术前30 min及术后8h给予生理盐水5 ml,P组分别于手术前30 min及术后8h静脉注射帕瑞昔布钠40 mg.于术前30 min（T1）、手术开始后2 h（T2）和术后12 h（T3）采集患者中心静脉血检测血浆PGE2浓度.评估记录患者手术后12、24、48 h的静息和动态视觉模拟评分法（VAS）疼痛评分、PCA舒芬太尼消耗量及有效按压次数、相关不良反应及镇痛满意度评分.结果 与T1时比较,S组和P组T2时血浆PGE2水平均降低（P＜0.05）,T3时血浆PGE2水平均升高（P＜0.05）；与S组比较,P组血浆PGE2水平T2时（135.95 ± 30.27比147.78±19.70）和T3时（168.03±29.15比182.61±28.36）显著降低（P＜0.05）；术后12 h时P、S组静息VAS疼痛评分分别为（12.73±12.41）分和（23.64±15.29）分（P＜0.05）；动态VAS评分分别为（13.18±13.14）分和（23.63±15.29）分（P＜0.05）；24 h时P、S组静息VAS疼痛评分分别为（l0.00±8.73）分和（17.27 ±9.84）分（P＜0.05）；动态VAS评分分别为（10.90±8.11）分和（17.27 ±9.84）分（P＜0.05）；PCA有效按压次数P组少于S组（P＜0.05）；两组相关不良反应发生率差异无统计学意义（P＞0.05）；P组镇痛满意程度高于S组（P＜0.05）.结论 帕瑞昔布钠可显著抑制外周血浆PGE2的生成,有效改善腹腔镜辅助下胃癌手术患者术后自控镇痛的临床效果.

Objective To investigate the effect of parecoxib sodium on levels of prostaglandin E2 （PGE2） in plasm and patient-controlled analegsia （PCA） after laparoscopic gastrectomy.Methods Ninety gastric cancer patients scheduled for elective laparoscopic gastrectomy accepting PCA were randomly divided into 2 groups：control group （group S） and parecoxib sodium grou （group P）.Group S received intravenous normal saline （5 ml） 30 min before incision and 8 h after operation respectively.Group P received intravenous parecoxib sodium （40 mg） 30 min before incision and 8 h after operation respectively.Venous blood samples were collected 30 min before incision （T1）,2 h after surgery beginning （T2） and 12 h after operation （T3） to test PGE2 concentrations.The visual analogue scale （VAS） for assessing resting and motion pain at 12,24 and 48 h after operation,the consumption of sufentanil,effective number of PCA,the side effects and patient satisfaction were recorded.Results The levels of PGE2 were significantly lower at T2 in group S and group P than at T1 （P ＜ 0.05）,higher at T3 （P ＜ 0.05）.As compared with group S,the levels of PGE2 at T2（135.95 ± 30.27 vs.147.78 ± 19.70） and at T3 （168.03 ±29.15 vs.182.61 ± 28.36） were significantly lowered in group P （P ＜ 0.05）.The resting VAS of pain at 12 h after operation in group P and group S was separately 12.73 ± 12.41 and 23.64 ± 15.29 （P ＜0.05）,abd the motion VAS of pain was 13.18 ± 13.14 and 23.63 ± 15.29 （P ＜0.05）.The resting VAS of pain at 24 h after operation in group P and group S was separately 10.00 ± 8.73 and 17.27 ± 9.84 （P ＜ 0.05）,and the motion VAS of pain wase 10.90 ± 8.11 and 17.27 ± 9.844 （P ＜ 0.05）.The effective number of PCA was significantly less in group P than in group S （P ＜ 0.05）.No significant differences were found between two groups at the side effects （P ＞ 0.05）.The patient satisfaction was better in group P than in group S （P ＜ 0.05）.Conclusion Parecoxib sodium could siginificantly suppress the production of PGE2 and improve the effect of PCA after laparoscopic gastrectomy.