帕瑞昔布钠对眼内容剜除联合义眼座植入手术后镇痛效果的影响

Postoperative analgesic effects of parecoxib sodium on the surgery of evisceration with implantation

目的观察帕瑞昔布钠对眼内容剜除联合义眼座植入手术患者术后镇痛效果的影响。设计随机对照临床试验。研究对象复旦大学附属眼耳鼻喉科医院眼科连续收治的在全麻下行眼内容剜除联合义眼座植入手术的患者60例。方法采用随机数字表法将以上患者分为两组，A组在全麻诱导前和手术结束前分别静脉注射帕瑞昔布钠40mg，术后第1天起每天2次给予肌肉注射帕瑞昔布钠40mg，共2天；B组在上述时间点静脉注射或肌肉注射2m1生理盐水。采用视觉模拟评分法（VAS）记录苏醒后即刻（T1）、术后4h（T2）、24h（T3）、48h（T4）的镇痛效果，观察药物的副作用。主要指标VAS评分，药物副作用。结果T1。T3时A组VAS评分分别为1．83±0．70、1．17±0．65、0．93±0．58；B组VAS评分分别为2．87±1．04、2．30±0．92、1．40±0．62。A组评分明显低于B组，差异有统计学意义（P均=0．000）。T4时两组评分分别为0．57±0．50、0．67_＋0．57，两组比较差异无统计学意义（P-0．051）。未观察到帕瑞昔布钠明显的副作用。结论帕瑞昔布钠对于眼内容剜除联合义眼座植入手术的患者术后早期（24小时内）具有良好的镇痛作用。

Objective To investigate the postoperative analgesic effects of parecoxib sodium on the surgery of evisceration with implantation. Design Randomized controlled clinical trial. Participants Continuous 60 patients undergoing evisceration with implanta- tion surgery under general anesthesia in department of ophthalmology, Eye and ENT Hospital, Fudan University. Methods Sixty patients undergoing evisceration with implantation surgery under general anesthesia were randomly divided into 2 groups of thirty： Group A re- ceived parecoxib sodium 40 mg by intravenous injection before anesthesia induction and before the end of surgery. Parecoxib sodium 40 mg was also administrated by muscle injection twice a day in the next two days postoperatively. Group B received 2 ml saline by intra- venous injection or by muscle injection at the same time. Visual analog score （VAS） was recorded to evaluate postoperative pain at the time of analepsia （T1）, 4 h（T2）, 24 h（T3） and 48 h（T4） after the surgery. Side effects of parecoxib sodium were also recorded. Main Outcome Measures Visual analog score, side effects. Results The VAS scores at T1-T3 in Group A were 1.83±0.70, 1.17±0.65, 0.93＋ 0.58. The VAS scores at T1-T3 in Group B were 2.87±1.04, 2.30±0.92, 1.40±0.62. The VAS scores in Group A were significantly lower as compared with those in Group B （all P〈0.05）. There was no significant difference of VAS score between Group A and Group B at T4 （0.57±0.50 in Group A and 0.67±1.57 in Group B, P〉0.05）. No serious side effects were observed during the use of parecoxib sodium. Conclusion Administration of parecoxib sodium can provide good analgesia effects during early period after the surgery of evisceration with implantation.