芬太尼不同给药方式联合帕瑞昔布钠超前镇痛在椎间孔镜术中的应用效果

The Application Effect of Different Ways of Administration of Fentanyl Combined with Parecoxib Preemptive Analgesia in Transforaminal Endoscopic Surgery

目的探讨枸橼酸芬太尼注射液不同给药方式联合帕瑞昔布钠超前镇痛在椎间孔镜术中的应用效果。方法选择疼痛科收治的单节段腰椎间盘突出症行经皮椎间孔镜椎间盘髓核摘除术的患者共60例,按枸橼酸芬太尼注射液不同给药方式分为对照组（枸橼酸芬太尼注射液静脉注射联合帕瑞昔布钠超前镇痛）和观察组（枸橼酸芬太尼注射液纤维环注射联合帕瑞昔布钠超前镇痛）。观察术中不同时间点两组患者的生命体征,使用视觉模拟评分法评估术中、术后不同时间点的疼痛反应,使用改良Macnab判定术后疗效及不良反应。结果观察组术中T0~T5患者HR及MAP,T3~T5 VAS分值均与对照组有明显差异,生命体征变化及疼痛感较对照组小;观察组术后第6h及第1d神经痛较对照组轻;观察组不良反应发生率为0低于对照组的16.67%,术中枸橼酸芬太尼使用量较对照组少,术中药物追加发生率13.33%,较对照组的33.33%低;术后1d观察组烧灼感评分为1.80±0.30分,对照组灼烧感评分为2.60±0.26分（P〈0.05）。结论枸橼酸芬太尼注射液纤维环注射联合帕瑞昔布钠超前镇痛能取得较枸橼酸芬太尼注射液联合帕瑞昔布钠超前镇痛能取得更好的术中麻醉效果,但术中更安全,不良反应更少,术后神经痛及烧灼感减少。

Objective To investigate fentanyl citrate injection combined with different modes of administration of parecoxib sodium application of preemptive analgesia effect in a mirror foramen surgery choices pain clinic were single segment underwent lumbar disc herniation patients with skin foramen mirror discectomy.Methods A total of 60 cases of fentanyl citrate injection by different modes of administration were divided into control group（fentanyl citrate injection combined with intravenous parecoxib sodium preemptive analgesia） and observation group （fentanyl citrate injection annulus joint injection parecoxib sodium preemptive analgesia）.Two groups of patients at different time points intraoperative vital signs,use of visual analog scale assessment of postoperative pain response at different time points,determined using a modified Macnab curative effect and adverse reactions.Results The observation group surgery patients T0-T5hR and MAP,T3-T5 VAS scores were significantly different from the control group,changes in vital signs and pain than the control group small.The observation group after the first and second 1d 6h neuralgia compared with the control group light.Incidence of adverse reactions（0） than the control group（16.67%）,intraoperative fentanyl citrate used in an amount less than the control group,the incidence of intraoperative additional drugs（13.33%） than the control group（33.33%） lower.1d after burning sensation rated the observation group（1.80±0.30）points,a burning sensation in the control group score was （2.60±0.26）points（P〈0.05）.Conclusion Fentanyl citrate injection annulus injection combined with preemptive analgesia with parecoxib sodium can obtain more fentanyl citrate injection combined with preemptive analgesia with parecoxib sodium can achieve better anesthetic effect but surgery safer and less adverse reactions,reduce postoperative neuropathic pain and burning sensation.