帕瑞昔布联合塞来昔布在妇科腹腔镜手术围手术期的应用

Research on application of parecoxib associated with celecoxib in gynecologic perioperative laparoscopy

目的观察帕瑞昔布联合塞来昔布在妇科腹腔镜手术的镇痛效果和安全性,为临床术后镇痛提供参考。方法选择全麻下妇科腹腔镜手术患者158例,随机分为观察组与对照组,每组79例。观察组术前24小时给塞来昔布200 mg口服,术前12小时塞来昔布200 mg口服,切皮前30分钟给予帕瑞昔布40 mg静脉注射,手术结束前30分钟给予帕瑞昔布40 mg静脉注射,术后12小时帕瑞昔布40 mg静脉注射。对照组手术结束前30分钟给予帕瑞昔布40 mg静脉注射,术后12小时生理盐水2 m L静脉注射。两组术后若VAS评分>4分,则追加曲马多。记录两组患者术后清醒拔管1、4、8、12、24、48与72小时的VAS评分与追加曲马多药物剂量,统计分析术后不良反应发生情况、术前术后焦虑抑郁评分及术后慢性疼痛发生情况。结果观察组各个时点的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者术后并发症较对照组少,差异有统计学意义(P<0.05);观察组术前术后焦虑抑郁评分差值与对照组比较,差异有统计学意义(P<0.05)。结论帕瑞昔布联合塞来昔布在妇科腹腔镜手术术后镇痛有明显效果,减少了术后镇痛药物并发症发生,降低了术后疼痛评分,减少了其他类镇痛药使用量,缓解了术后焦虑抑郁情绪,预防了患者术后慢性疼痛的发生。

Objective To investigate the analgesic effect and safety of parecixib and celecoxib in gynecological laparoscopic surgery, so as to guide the clinical postoperative analgesic regimen. Methods A total of 158 cases of gynecologic laparoscopic surgery under general anesthesia were randomly divided into observation group and control group, with 79 cases in each. For obsmwation group： 200 mg celecoxib orally 24 h to preoperative, 200 mg celecoxib orally preoperative 12 h, intravenous injection of 40 mg parecixib 30 rain before skin incision, intravenous injection of 40 mg parecixib 3 rain before the end of surgery; intravenous injection of 40 mg parecixib 12 h after surgery; for con- trol group ： intravenous injection of 40 mg parecixib 30 min before the end of surgery, intravenous 2mL saline postoperative 12 h. If postoper- ative VAS of two groups was more than 4 points, an extra weak opioid tramadol was given. 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, 72 h VAS score of patients in two groups after extubation, and additional tramadol doses were recorded. The incidence of postoperative nausea and vomiting, urinary retention, dizziness, skin itching, respiratory depression and other adverse reactions, anxiety and depression score before and after surgery, and the occurrence of postoperative chronic pain were studied statistically. Results Each time point VAS score of obsmwation group was lower than that of the control group, and the difference was statistically significant （ P 〈 0.05 ）. Postoperative complications in obsmwa- tion group were relatively less than in the control group, and the difference was statistically significant （ P 〈 0.05 ）. The difference in preoper- ative and postoperative anxiety and depression score between the obsmwation group and the control group was statistically significant （P 〈 0.05 ）. Conclusion The preoperative analgesia of parecixib combined with celecoxib in gynecological laparoscopic operation has obvious an- algesic effect, which could reduce the occmTence of postoperative complications of analgesic drugs, decrease the postoperative pain score, re- duce other analgesic usage, alleviate postoperative anxiety depression, and prevent the happening of postoperative chronic pain in patients.