帕瑞昔布钠预防性镇痛应用于腹腔镜妇科手术的疗效

Efficacy of preventive analgesia of parecoxib sodium in patients undergoing gynecological laparoscopic operation

目的观察帕瑞昔布钠预防性镇痛在腹腔镜妇科手术中的临床效果。方法60例择期行妇科腹腔镜手术患者随机分为3组：对照组（c组）、帕瑞昔布钠超前镇痛组（P1组）和帕瑞昔布钠预防性镇痛组（P2组），每组20例。c组诱导前30min静脉注入生理盐水2mL，P1组手术开始前30min静脉注入帕瑞昔布钠40mg，P2组手术结束前30min静脉注射帕瑞昔布钠40mg。用视觉模拟评分（VAS）法评估患者术前、术后10min及术后6、12、24、48h的疼痛程度，记录3组患者术毕至术后6h、术后6～12h、术后12～24h、术后24～48h4个时间段镇痛药需求例数，观察各组苏醒期躁动、嗜睡、术后恶心呕吐、咽喉部疼痛等不良反应发生情况。结果3组患者术后VAS均有不同程度升高，术后10minC组明显高于P1、P2组（P〈0．05），术后6、12、24、48h4个时间点c组和P1组均高于P2组（P〈0．05）。c组手术结束至术后6h、术后6～12h、12～24h3个时间段镇痛药需求例数百分比均高于P2组（P〈0．05），P1组术后12～24h时间段镇痛药需求例数百分比高于P2组（P〈0．05），24～48h时间段3组镇痛药需求例数百分比之间差异无统计学意义。c组拔管后躁动发生率为15％，与P1、P2组差异无统计学意义。3组患者苏醒完全，未观察到嗜睡病例。3组恶心、呕吐的发生率差异无统计学意义。P1、P2组术后咽喉部疼痛的发生率明显低于C组（P〈0．05）。结论帕瑞昔布钠预防性镇痛可明显减轻妇科腹腔镜手术术后疼痛，不良反应少，且镇痛效果优于超前镇痛。

AIM To observe the clinical effect of preventive analgesia of parecoxib sodium in patients undergoing gynecological laparoscopic operation. METHODS Sixty patients scheduled for laparoscopic gynecological operation were randomly assigned to 3 groups ： control group （group C）, preemptive analgesia of parecoxib sodium group （ group P1 ） and preventive analgesia of parecoxib sodium group （group P2）, with 20 patients in each group. The control group received 0.9 % normal saline 2 mL by intravenous injection. Parecoxib sodium 40 mg was intravenously injected 30 min before op- eration in group P1 and 30 min before the end of the operation in group P2 respectively. Pain intensity was evaluated with visual analogue scale（VAS） before operation, 10 min,6,12,24 and 48 h after operation. The patients which needed analgesics were observed respectively during the periods of the end of operation to 6 h after operation,6 to 12 h, 12 to 24 h and 24 to 48 h after operation. The incidence rate of dysphoria, lethargy, nausea, vomiting and throat pain after operation were recorded. RESULTS VAS of all patients increased to different extent after operation. VAS was higher in group C than in group P1 and group P2 10 min after operation （ P 〈 0.05） and higher in group C and group P! than in group P2 （P 〈 0.05）at time points of 6,12,24 and 48 h after operation. The percentage of analgesic requirement of patients in group C was higher than in group P2 during three periods of the end of operation to 6 h after operation,6 to 12 h and 12 to 24 h after operation （ P 〈 0.05 ）, which was higher in group P1 than in group P2 during 12 to 24 h after operation （ P 〈 0.05）. The percentage of analgesic requirement of patients had no statistical differences in 3 groups during the pe- riod of 24 to 48 h after operation. The incidence rate of dysphoria in group C was 15 % and no statistical differences com- pared with group P1 and group P2. All patients in 3 groups were awoked completely and not lethargy. The incidence rate of nausea and vomiting had no statistical differences in 3 groups, while the incidence rate of throat pain in group P1 and group P2 was lower than in group C. CONCLUSION Preventive analgesia of parecoxib sodium can obviously reduce pain intensity in patients undergoing gynecological laparoscopic operation and has little adverse drug reaction. The efficacy of preventive analgesia of parecoxib sodium is better than that of preemptive analgesia.