不同时机给予帕瑞昔布对七氟醚麻醉患者的影响

Impact of Parecoxib Injected at Different Time on Patients under Sevoflurane Anesthesia

目的探讨在不同时机给予帕瑞昔布对七氟醚麻醉患者的影响。方法选择ASAI～Ⅱ级择期行腹腔镜次全子宫切除的手术患者60例，随机分为3组，每组20例。A组（麻醉后组）：麻醉诱导后静脉注射帕瑞昔布40mg；B组（术中组）：切除子宫后静脉注射帕瑞昔布40mg；C组（术后组）：术毕静脉注射帕瑞昔布40mg。麻醉诱导：咪唑安定0．1mg／kg、芬太尼4μg／kg、顺阿曲库胺0．15mg／kg、依托咪酯0．2rag／kg。麻醉维持：七氟醚1．0～1．5MAC持续吸入（0，流量：2L／min），泵注顺阿曲库胺0．1rag／（kg·h），间断追加芬太尼，保证术中满意的镇痛。3组术后均采用静脉自控镇痛（PCIA），维持术后VAS评分〈3分，比较3组术中、术后24h的芬太尼用量、苏醒时间、拔管时间、不良发应及患者满意度。结果3组术中及术后24h芬太尼用量有统计学差异（P〈0．05），以术后组用量最大，术中组用量其次，麻醉后组用量最小。3组的苏醒时间、拔管时间有统计学差异（P〈0．05），以术后组最长，术中组次之，麻醉后组最短。3组的不良发应发生率有统计学差异（P〈0．05），术后组的恶心、呕吐及皮肤瘙痒发生率明显高于其他两组。患者满意度以麻醉后组最高。结论麻醉后给予帕瑞昔布可减少七氟醚麻醉时阿片类药物的用量，缩短了苏醒时间及拔管时间。降低了不良反应的发生率，同时增加了患者的满意度。

Objective To investigate the effect of parecoxib on opioids in anesthetized patients at different time. Methods Select- ed 60 patients who had ASA I - II scheduled laparoscopic subtotal hysterectomy operation, randomly divided into 3 groups, 20 patients in each group. Group A （ after anesthesia group） ： parecoxib 40rag was injected after induction of anesthesia; Group B （ intraoperative group） ： parecoxib 40mg was injected after hysterectomy cut; C group （postoperative group） ： parecoxib 40mg was injected after opera- tion. Anesthesia induction： midazolam 0. lmg/kg, fentanyl 41μg/kg, cisatraeurium 0.15mg/kg, etomidate 0.2mg/kg. Anesthesia main- tainance ： sustained inspiration of sevoflurane 1.0 - 1.5 MAC, cisatracurium O. lmg/（ kg ~ h） was pumped, fentanyl was injected inter- mittently, which provide satisfactory operative analgesic effect. All the three groups were evalued by patients controlled intravenous analge- sia （PCIA） , the VAS score was maintained at 〈 3 points,these three groups was compared with 24h fentanyl dosage, awake time, extu- bation time, adverse reaction and patient satisfactary degree. Results There was difference in fentanyl 24h dosage in these three groups （P 〈0.05） , group A exhibited the most, while group B took the second place, the mininum dosage happened in group C. There were differences in recover time, extubation time within these three groups, too （ P 〈 0.05 ） , group C expressed the maximum time, group B took the second place, the minimum time happened in group A. There were also differences in the rate of adverse effects and patients＇ sat- isfactory degree within these three groups （P 〈 0.05）. There was higher rate of nausea, vomit and pruritus in the group C. The highest patients＇ satisfactory degree took place in the group A. Conclusion Parecoxib injected after anesthesia may decrease the dosage of opi- oids under sevoflurane anesthesia patient and shorten the recover time and extubation time. The rate of adverse effect and patients＇ satis- factory degree are superior in after anesthesia group to the other two groups.