帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响

Analysis of the Influence of Parecoxib Sodium on the Recovery Period after Laparoscopic Cholecystectomy under Fast Track Anesthesia with Remifentanil Later

目的探讨帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术(LC)后苏醒期的影响。方法选择2013年3月至2014年2月韶关市第一人民医院收治的114例胆囊结石患者为研究对象,按照随机数字表法分为对照组(56例)和观察组(58例)。两组均行瑞芬太尼快速通道麻醉下LC治疗,观察组麻醉前20 min注射5 m L生理盐水与帕瑞昔布钠混合液,对照组注射5 m L生理盐水。记录清醒及拔管时间,同时观察拔管前5 min(T1)、拔管时(T2)、拔管后5 min(T3)及拔管后15 min(T4)的平均动脉压(MAP)、脉搏血氧饱和度(Sp O2)、苏醒期心率等变化情况,均行Ramsay镇静及疼痛视觉模拟评分(VAS),观察躁动、心律失常等不良反应。结果观察组MAP、心率仅在T2时间段出现波动,随后趋于平缓;对照组MAP、心率均自T1后出现明显波动,两组间比较差异有统计学意义(P<0.05)。观察组术后躁动评分和VAS分别为(1.8±0.9)分、(2.3±1.2)分,低于对照组的(3.4±1.0)分和(4.2±1.3)分;观察组术后Ramsay镇静评分高于对照组[(3.5±1.1)分比(1.7±0.8)分],差异均有统计学意义(均P<0.01)。观察组术后躁动发生率低于对照组[10.3%(6/58)比30.4%(17/56)],差异有统计学意义(P<0.01)。结论采取瑞芬太尼快通道麻醉行LC,应用帕瑞昔布钠行术前麻醉诱导,能稳定血流动力学,减轻术后疼痛及应激反应,且不良反应少,有临床推广价值。

Objective To observe the influence of parecoxib sodium on the recovery period after laparo-scopic cholecystectomy（LC） under fast trackanesthesia with remifentanil.Methods A total of 114 cases of gallstone admitted in Shaoguan First People′s Hospital from Mar.2013 to Feb.2014 were divided into the control group（56 cases） and observation group（58 cases） by random number table method.Patients in both groups received LC treatment under fast track anesthesia with remifentanil,patients in the observation group receivedinjection of 5 mL saline and parecoxib sodium mixture 20 min before anesthesia,while patients in the control group received injection of 5 mL saline.The awake and extubation time of the two groups was recor-ded,while changes of mean pulsating pressure（ MAP） ,pulse oxygen satuation （ SpO2 ） ,heart rate and other indicators of recovery period were observed at the time points of 5 min before extubation （ T1 ） ,extubation time （ T2 ） ,5 min after extubation （ T3 ） and 15 min after extubation （ T4 ） ,besides,Ramsay sedation and VAS pain scores were recorded,incidences of restlessness,arrhythmia and other adverse reactions were observed.Results MAP,heart rate of the observation group only fluctuated at T2 ,then leveled off;MAP,heart rate of the controlgroup significantly fluctuated after T1 ,there was statistically significant difference between the two groups（P 〈0.05）.Postoperative agitation score and VAS pain score of the observation group were （1.8 ±0.9） scoresand （2.3 ±1.2） scores,siginificantly lower than those of the control group[（3.4 ±1.0） scores and （4.2 ±1.3） scores],while Ramsay sedation score was higher than the control group [（3.5 ±1.1） scores vs（1.7 ±0.8） scores],the difference was statistically significant（P 〈0.01）.The incidence of agitation of theobservation group was lower than the control group [10.3% （6/58） vs 30.4% （17 /56）],the differencewas statistically significant（P 〈0.01）.Conclusion Application of parecoxib sodium to induce the fasttrack anesthesia with remifentanil before LC can stable the hemodynamics,reduce postoperative pain andstress response,with fewer adverse reactions,therefore,it is worth for clinical promotion.