帕瑞昔布钠联合皮下局部麻醉镇痛系统在开腹肝癌根治术后镇痛效果观察

Effect of parecoxib united with local anethsia analgesia system on analgesia after radical resection of liver cancer

目的探讨帕瑞昔布钠联合皮下局部麻醉镇痛系统在开腹肝癌根治术后镇痛效果。方法90例择期行开腹肝癌根治术患者按随机数字表法分为三组，每组各30例，帕瑞昔布钠组（P组），手术结束前30min静脉注射帕瑞昔布钠40mg，术后12、24、36h分别注射帕瑞昔布钠40mg；局部麻醉镇痛系统组（L组），手术切口皮下埋置渗透导管，外接输注泵，输注泵内充入0．25％罗哌卡因250ml，输注速度4ml／h；联合镇痛组（u组），采用帕瑞昔布钠联合皮下局部麻醉镇痛系统术后镇痛，分别采用前述方法；各组若疼痛视觉模拟量表（VAS）评分〉5分时，肌肉注射哌替啶50mg。观察各组拔管后即刻（T0）、术后2h（T1）、6h（T2）、12h（T3）、24h（T4）、48h（T5）静息和运动VAS评分和Ramsay镇静评分，不良反应发生率，哌替啶用量，镇痛满意度，并进行比较。结果P组、L组各时间点静息、运动VAS评分以及Ramsay镇静评分比较差异无统计学意义（P〉0．05）。U组各时间点静息、运动VAS评分显著低于P组和L组，Ramsay镇静评分显著高于P组和L组，差异均有统计学意义（P〈0．05）。三组恶心、呕吐发生率比较差异无统计学意义（P〉0．05）。U组嗜睡发生率显著低于P组和L组[6．67％（2／30）比26．67％（8／30）、23．33％（7／30）]，差异有统计学意义（P〈0．05）；U组追加镇痛药哌替啶用量显著低于P组和L组[（10．23±4．28）mg比（69．75±25．26）、（72．75±27．28）mg]，差异有统计学意义（尸〈0．05）；U组镇痛满意度显著高于P组和L组[93．33％（28／30）比56．67％（17／30）、53．33％（16／30）]，差异有统计学意义（P〈0．05）。结论帕瑞昔布钠联合局部麻醉镇痛系统应用于开腹肝癌根治术后可达到良好的镇痛效果。

Objective To observe the effect of parecoxib united with local anaesthesia analgesia system on analgesia after radical resection of liver cancer. Methods Ninety patients undergoing elective radical resection of liver cancer were randomly assigned to three groups, with 30 patients in each group. The patients in parecoxib group （P group） received parecoxib 40 mg through vein before the end of operation for 30 min, and were injected parecoxib 40 mg at 12 h, 24 h and 46 h after operation. The patients in local anethsia analgesia system group （L group） received embedding hypodermic pervasion canal in incision subcutaneously, then connected the pump with 0.25% ropivacaine 250 ml, with infusion speed of 4 ml/h.The patients in united group（U group）receieed the same methods with those in P group and L group. When the patients ＇ visual analogue scale （VAS） scores were higher than 5 scores, they were given muscle injection of pethidine 50 mg. The VAS scores and Ramsay sedation scores at the time of tracheal extubation （To）, postoperative 2 h（T1）, 6 h（T2）, 12 h（T3）, 24 h（T4） and 48 h（T5）, the adverse reaction rate, dosage of pethidine, and analgesia satisfaction were compared. Results The resting and movement of VAS scores and Ramsay sedation scores at each time in P group and L group had no significant difference （P 〉 0.05）. The resting and movement of VAS scores and Ramsay sedation scores at each time in U group were significantly better than those in P group and L group （P 〈 0.05）. The rate of nausea and vomiting in three groups had no significant difference among three groups （P 〉 0.05）. The rate of drowsiness in U group was significantly lower than that in P group and L group： 6.67%（2/30） vs. 26.67% （8/30） and 23.33% （7/30）, P 〈 0.05. The analgesia satisfaction in U group was significantly higher than that in P group and L group ： 93.33%（28/30） vs. 56.67%（17/30） and 53.33%（16/30）, P 〈 0.05. Conclusions The analgesia effect of the parecoxib united with local anaesthesia analgesia system for radical resection of liver cancer is perfect.