帕瑞昔布钠和氟比洛芬酯术前静注对腭咽成形术后镇痛及血小板聚集的影响

Effects of advance intravenous parecoxib and flurbiprofen axetil on postoperative analgesia and platelet aggregation in patients undergoing uvulopalatopharyngoplasty

目的 比较术前静脉注射帕瑞昔布钠与氟比洛芬酯对腭胭成形术（UPPP）术后镇痛及血小板聚集的影响.方法 拟在全麻下行UPPP的男性患者75例,年龄35～60岁,随机均分为三组,分别在麻醉诱导前10 min静脉注射帕瑞昔布钠0.6mg/kg（P组）、氟比洛芬酯1 mg/kg（F组）或生理盐水（C组）.所有患者均在手术结束前行切口周围0.5％罗哌卡因5 ml局部浸润注射.于麻醉前30 min（T1）、舌腭弓根部切开时（T2）、舌腭弓根部切开后45 min（T3）、术毕120 min（T）采集静脉血检测血清IL-6浓度.于术前、术后2、4、6、12 h采集静脉血测定血小板聚集率.记录术后2、4、6、12、24 h的静息和吞咽时疼痛VAS评分和术后出血、恶心呕吐、上呼吸道梗阻等不良反应情况.结果 T3、T4时P组和F组血清IL-6浓度明显低于C组（P＜0.05）.术后6hP组和F组静息VAS评分和吞咽时的VAS评分均明显低于C组（P＜0.05）.三组患者不同时点血小板凝集率差异无统计学意义.结论 术前静脉注射帕瑞昔布钠0.6 mg/kg或氟比洛芬酯1mg/kg均减少患者术中及术后血清IL-6浓度,缓解UPPP术后疼痛,且不影响血小板凝集率.

Objective To compare the effects of advance intravenous parecoxib and flurbiprofen axetil on postoperative analgesia and platelet aggregation in patients undergoing uvulopalatopharyngoplasty （UPPP）.Methods Seventy-five male patients,aged 35-60 years,who underwent UPPP under general anesthesia,were equally randomized into three groups：0.6 mg/kg of parecoxib （group P）,or 1.0 mg/kg flurbiprofen axetil （group F）,or equal volume of saline （group C） were intravenously injected before intubation.The incision-local block was performed with 5 ml of 0.5 ％ ropivacaine before the end of surgery in all three groups.Serum levels of IL-6 were detected at 30 min before induction （T1）,slit the root of the palatal arch （T2）,45 min after palate bow root incision （T3） and 120 min after operation （T4）,respectively.The venous blood was collected preoperatively and 2,4,6,12 h postoperatively to measure platelet aggregation.VAS pain scores were evaluated at the time of 2,4,6,12 and 24 h after UPPP.The incidences of postoperative adverse reactions （e.g.：postoperative bleeding,nausea and vomiting,upper airway obstruction） were monitored.Results At T3 and T4,the IL-6 concentrations in groups P and F were both lower than that in group C at the same point （P＜0.05）.The resting and swallowing VAS scores in groups P and F were lower than that in group C at 6 h after operation （P＜0.05）.The platelet aggregation was not significantly different among the three groups at all time points.Conclusion Both advance intravenous parecoxib sodium 0.6 mg/kg and flurbiprofen axetil 1 mg/kg in patients undergoing UPPP reduce intraoperative and postoperative IL-6 generation and provide similar preemptive analgesic effects without affecting platelet aggregation