帕瑞昔布钠对开腹手术患者术后自控镇痛的影响

THE EFFECTS OF PARECOXIB ON POSTOPERATIVE PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING LAPAROTOMY

目的：探讨帕瑞昔布钠对开腹手术患者术后自控镇痛的影响。方法：将60例ASAⅠ～Ⅱ级行开腹手术的患者随机分成3组：术前组（PR组）、术后组（PO组）和对照组（CO组），每组20例。PR组患者于麻醉诱导前予静脉注射帕瑞昔布钠40mg，PO组患者手术结束即刻予静脉注射帕瑞昔布钠40mg，CO组患者不使用帕瑞昔布钠。用11点数字评分法（NRS-11）单盲评估患者拔管后4，8，12，24，48h的术后疼痛程度，观察术后48h内镇痛装置的有效触发次数以及术后恶心呕吐、呼吸困难等不良反应的发生情况。结果：3组患者年龄、性别、身高、体重、麻醉时间和手术时间等一般情况比较差异无统计学意义（P〉0．05）；PR组、PO组术后4，8，12，24，48h的NRS-11评分较CO组降低（P〈0．05），术后48h内镇痛装置的有效触发次数较CO组明显减少（P〈0．05）；而PR组、PO组术后NRS-11评分及48h内镇痛装置的有效触发次数比较，差异无统计学意义（P〉0．05）。3组术后恶心呕吐、呼吸困难等发生率比较，差异无统计学意义（P〉0．05）。结论：帕瑞昔布钠无论是麻醉诱导前还是手术结束即刻静脉注射，均可增强术后自控镇痛的效果、减少镇痛药物的用量，且不增加术后不良反应事件的发生率。

Objective：To investigate the effects of parecoxib on postoperative patient-controlled analgesia in patients undergoing laparotomy. Methods： Sixty patients （ASA Ⅰ～Ⅱ ） undergoing laparotomy were ran- domly divided into three groups （ n =20） ： pre-operation group （group PR）, post-operation group （group PO） and control group （group CO）. The patients in group PR were injected with parecoxib 40 mg intrave- nously before anesthesia induction, and the patients in group PO were injected parecoxib 40 mg intrave- nously at once after operations while patients in group CO were treated without parecoxib. The degree of post-operative pain was accessed with the 11-point numeric rating scale （NRS-11） at 4, 8, 12, 24 and 48 h after the extubation. The total effective counting of PCIA in 48 h and the adverse reactions such as nausea, vomiting and respiratory inhibition were recorded after operation. Results：Age, sex ratio, height, weight, the time of anesthesia and the time of operation were not different among the three groups （ P 〉0.05）. The pain scores at each time point and the total effective counting of PCIA in 48 h in group PR and group PO were significantly lower than those in group CO （ P 〈0.05）, and no significant differences were found between groups PR and PO （ P〉0.05）. The adverse reactions such as nausea, vomiting and dyspnea were not different among the three groups （ P〉0.05）. Conclusion：Parecoxib could enhance the effects of post- operative patient-controlled analgesia, decrease the consumed dose of analgesics, and not increase the inci- dence of adverse reactions after operation in patients undergoing laparotomy.