短效氯胺酮和长效帕瑞昔布钠预先镇痛效果的比较

The comparison of preemptive analgesic efficacy between short-acting ketamine and long-acting parecoxib

目的 比较术前单次注射短效的氯胺酮或长效的帕瑞昔布钠在减少术后24 h镇痛药用量方面的差异.方法 收集2015年4至12月北京朝阳医院在静脉全身麻醉下实施腹腔镜子宫手术患者81例,随机数字表法分为3组:空白对照组(C组)、氯胺酮组(K组)、帕瑞昔布钠组(P组).麻醉后手术切皮前10 min分别静脉注射干预用药:K组0.5 mg/kg氯胺酮、P组40 mg帕瑞昔布钠、C组生理盐水2 ml.术后全部采用舒芬太尼患者静脉自控镇痛(PCIA).主要观察指标为术后1h和24 h内舒芬太尼的总用量,其他指标包括用视觉模拟评分(VAS)法评估术后0、15、30、45 min以及1、2、8、12、24 h的疼痛程度,PCIA触发次数,以及不良反应等.结果 K组和P组患者在术后1h内的舒芬太尼总需求量分别为(4.420±1.836)、(2.878±1.984) μg,术后24 h内分别为(28.200±3.712)、(25.511±4.037)μg,均显著小于C组的(6.144±2.346)、(31.505±7.042) μg,差异均有统计学意义(F=15.360、8.406,均P<0.05).P组术后1h内舒芬太尼用量少于K组(P<0.05),而24 h的总需求量与K组差异无统计学意义(P>0.05).C组、K组和P组术后24 h内PCIA的按压次数分别为2(3.75)、0(1.50)和0(1.00)次,与C组相比,K组和P组按压次数显著减少,差异均有统计学意义(均P<0.05).与C组相比,K组术后0、15、30 min,P组术后0、15、30、45 min以及2 h VAS评分明显降低,差异均有统计学意义(均P <0.05).3组不良反应发生率差异均无统计学意义(均P>0.05).结论 腹腔镜子宫手术术前单次注射短效的氯胺酮或长效的帕瑞昔布钠在减少术后24h镇痛药用量方面效果相似,但术后早期帕瑞昔布钠的镇痛表现更优于小剂量氯胺酮.

Objective To compare the analgesic efficacy between preoperative single-dose ketamine,a short-acting medicine and parecoxib,a long-acting medicine for reducing analgesic consumption in the first 24 h after-operation.Methods Eighty-one patients from Beijing Chaoyang Hospital undergoing laparoscopic uterus surgery between April and December 2015 were randomly divided into three groups:control group (group C),ketamine group (group K) and parecoxib sodium group (group P).All patients were anesthetized with general anesthesia and received sufentanil-based patient-controlled intravenous analgesia (PCIA).After induction and 10 min before incision,patients in group K,P and C were injected with intravenous 0.5 mg/kg ketamine,40 mg parecoxib and 2 ml normal saline,respectively.The primary outcome was sufentanil consumption within 1 h and 24 h after surgery.Other outcomes included the visual analog scale (VAS) pain score at 0,15,30,45min and 1,2,4,8,24 h after surgery,PCIA effective trigger times,and adverse reactions.Results The postoperative sufentanil consumptions within 1 h in group K and P were(4.420 ± 1.836) μg and (2.878 ± 1.984) μg,respectively,and consumptions within 24 h were(28.200 ±3.712) μg and (25.511 ±4.037) μg,respectively,which were significantly less than that in group C with (6.144 ± 2.346) μg within 1 h and (31.505 ± 7.042) μg within 24 h (F =15.360,8.406,all P < 0.05).Patients in group P needed less sufentanil than group K in 1 h after surgery (P < 0.05),however,the difference was not statistically significant in 24 h(P > 0.05).The PCIA trigger times were 2 (3.75) in group C,0(1.50) in group K,and 0(1.00) in group P.Group K and P had less PCIA trigger times compared to group C (all P < 0.05).Compared to group C,group K and P had lower VAS scores at 0,15,30 min after surgery and group P had lower VAS scores at 1,15,30,45 min,2 h after surgery,respectively (all P < 0.05).There were no differences between groups in the incidence of any adverse effects(all P > 0.05).Conclusion A single injection of short-acting ketamine before laparoscopic uterus surgery,has the same efficacy as long-acting parecoxib for opioid-sparing effect in the first 24 h afteroperation.However,parecoxib has better analgesic effect in the early postoperative period.