帕瑞昔布钠预防上腹部手术术后躁动临床观察

Effects of parecocib sodium on prevention of emergence agitation during the recovery period of general anesthesia for the patients undergoing epigastric surgeries

目的 观察帕瑞昔布钠预防上腹部手术苏醒期躁动的效果及安全性. 方法 美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级择期行上腹部手术患者120例按随机数字表法分为4组,每组30例.所有患者采用七氟醚、瑞芬太尼复合全麻,术中监测并维持脑电双频指数（bispectral index,BIS）值在40～50,A组于麻醉诱导前静脉注射帕瑞昔布钠0.8 mg/kg,B组于关腹前静脉注射帕瑞昔布钠0.8 mg/kg,C组于关腹前静脉注射静脉给予舒芬太尼0.08 μg/kg,D组于麻醉诱导前静脉注射生理盐水2ml.分别于麻醉诱导前（T1）、拔除气管导管前（停药10 min,T2）、拔管时（T3）、拔管后10 min （T4）,观察两组平均动脉压（meanarterial pressure,MAP）、心率（heart rate,HR）、脉搏血氧饱和度（oxygen saturation,SpO2）及T4时躁动评分（restlessness score,RS）、视觉模拟评分法（visual analogue scales,VAS）、Ramsay镇静评分（ramsay sedation score,RSS）、瑞芬太尼用量、术后30 min恶心呕吐发生率. 结果 苏醒时间,A组、B组、D组分别为（7±3）、（8±4）、（7±3） min显著短于C组（10±4）min（P＜0.05）;瑞芬太尼用量,A组为（0.8±0.3） mg,较D组（1.3±0.5）mg明显减少（P＜0.05）,差异有统计学意义.D组在T3时间点MAP、HR分别为（126±25） mmHg（1 mmHg=0.133 kPa）,（106±28）次/min,较A组[（106±25） mmHg,（96±25）次/min]、B组[（113±27） mmHg,（99±27）次/min]和C组[（111±27） mmHg,（86±19）次/min]升高,差异有统计学意义（P＜0.05）,T4时间点也有相似变化.与对照组D组比较,A、B、C组患者术后躁动总发生率分别为6.7％,13.2％,10.0％,均低于对照组术后躁动总发生率33.3％,其中A组躁动总发生率低于B组（P＜0.05）.A、B、C组患者VAS评分中位数分别为2、3、2均低于对照组评分5（P＜0.05）;A、B、C组患者RSS评分中位数分别为3、3、3均显著低于C组4分（P＜0.05）.与C组比较,A、B、D组副作用包括恶心,呕吐,嗜睡,呼吸抑制等发生率均显著低于C组（P＜0.05）. 结论 帕瑞昔布钠用于上腹部手术中,可减少瑞芬太尼的用量,并可预防苏醒期躁动与术后恶心呕吐的发生.

Objective To observe the preventive effects of parecoxib sodium on occurring of emergence agitation during the recovery period of general anesthesia for the patients who underwent epigastric surgeries.Methods one hundred and twenty patients,ASA Ⅰ ～ Ⅱ,underwent elective epigastic surgeries were divided randomly into four groups,30 cases in each group.Anesthesia of all patients was maintained with sevoflurane and remifentanil,keeping the bispectral index （BIS） around 40-50.Parecocib 0.8 mg/kg was intravenously infused into the patients just before anesthesia induction in group A and just before the closure of peritoneum in group B,Sufentanil 0.08 μg/kg was injected just before the closure of peritoneum in group C,2 ml saline as placebo was administrated in group D.The level of agitation（RS）,visual analogue scales（VAS） and ramsay sedation score（RSS） were evaluated during the recovery period of general anesthesia.Mean arterial pressure（MAP） and heart rate（HR）were monitored at preinduction （T1）,10 min before tracheal extubation （T2）,immediately after tracheal extubation （T3） and 10 min after tracheal extubation （T4）.Results The recovery time of group A,B,D（7±3）,（8±4）,（7±3） min is significantly shorter than that of group C.Requirement of remifentanil in group A （0.8±0.3） mg is significantly lower than that of group D （1.3±0.5） mg （P＜0.05）.At T3,the MAP and HR in group D（126±25） mmHg（1 mmHg=0.133 kPa）（106±28） beats/min were significantly higher than those in group A [（106±25） mmHg,（96±25） beats/min],group B [（113±27） mmHg,（99±27） beats/min],group C [（111±27） mmHg,（86± 19） beats/min]（P＜0.05）,which happened similarly at T4.Compared with group D,the incidence of agitation （33.3％） is significantly higher than that of group A （6.7％）,group B （13.2％） and group C （10.0％） （P＜0.05）,and the incidence of agitation group A is significantly lower than group B （P＜0.05）.Compared with group D,the median of score of VAS is 5,which is significantly higher than that of group A （2）,group B （3）,and group C （2） （P＜0.05）,Compared with group D,the median of score of RSS is 4,which is significantly higher than that of group A （3）,group B （3） and group C （3） respectively （P＜0.05）.The incidence of nausea and vomiting of group C is much higher than other groups significantly （P＜0.05）.Conclusions Parecoxib sodium has an analgesic effect for the patients of epigastric surgeries,preventing the incidence of postoperative agitation and adverse reactions during the recovery period of general anesthesia.