帕瑞昔布预防盐酸瑞芬太尼麻醉后痛觉过敏的临床观察

Clinical Observation of Parecoxib Preventing Hyperalgesia after Remifentanil Hydrochloride Anesthesia

目的：观察帕瑞昔布预防盐酸瑞芬太尼麻醉后患者痛觉过敏的临床疗效与安全性。方法：选取我院140例拟行腹腔镜胆囊切除术的患者,按照随机数字表法分为A、B、C、D组,各35例。4组患者的麻醉诱导前给药和麻醉诱导方案一致;麻醉维持方案为持续泵入注射用盐酸瑞芬太尼[A、C组患者0.1μg/（kg·min）,B、D组患者0.3μg/（kg·min）]＋丙泊酚注射液4-8 mg/（kg·h）＋注射用苯磺酸顺阿曲库铵0.12 mg/（kg·h）;C、D组患者在手术结束前15 min均给予注射用帕瑞昔布钠40 mg,iv。观察4组患者的心率（HR）、平均动脉压（MAP）水平,盐酸瑞芬太尼用量、丙泊酚用量、意识恢复时间、拔管时间和拔管即刻警觉/镇静评分（OAA/S）等麻醉情况及疼痛视觉模拟量表（VAS）评分,并记录患者不良反应发生情况。结果：4组患者拔管即刻HR、MAP水平均较入室后上升,B组患者上升最为明显,差异有统计学意义（P〈0.05）。B、D组患者盐酸瑞芬太尼用量均明显高于A、C组,C、D组患者拔管即刻OAA/S评分均明显高于A、B组,差异均有统计学意义（P〈0.05）。B、C、D组患者术后1、2、6、12、24 h的VAS评分均明显低于A组,D组患者明显低于C组,差异有统计学意义（P〈0.05）。B、C、D组患者追加镇痛药物、发生躁动和寒战等不良反应的比例均明显低于A组,D组患者追加镇痛药物和发生躁动的例数明显少于C组,差异均有统计学意义（P〈0.05）。结论：手术结束前15 min给予帕瑞昔布40 mg能够有效预防盐酸瑞芬太尼麻醉后患者痛觉过敏的发生,且安全性较高。

OBJECTIVE： To observe the clinical efficacy and safety of parecoxib preventing hyperalgesia after remifentanil hy- drochloride anesthesia. METHODS： 140 patients undergoing selective laparoscopic cholecystectomy were selected from our hospital and randomly divided into group A, B, C and D, with 35 cases in each group. Drug use of 4 groups before anesthesia induction was in line with anesthesia induction plan. Anesthesia maintenance plan was that continuous pump of Remifentanil hydrochloride for injection [0.1 μg/（kg·min） for group A and C, 0.3 μg/（kg·min） for group B and D]＋Propofol injection 4-8 mg/（kg·h）＋Cisatra- curium besilate for injection 0.12 mg/（kg·h） ; group C and D were given parecoxib 40 mg, iv, 15 min before the end of surgery. HR, MAP, the amount of remifentanil hydrochloride and propofol, awareness recovery time, extubation time, alertness/sedation score （OAA/S） immediately after extubation, VAS score were observed, and the occurrence of ADR was recorded. RESULTS： HR and MAP of 4 groups immediately after extubation were increased, compared to after entering surgery room, especially in group B, with statistical significance （P〈0.05）. The amount of remifentanil hydrochloride in group B and D were significantly higher than in group A and C, and OAA/S of group C and D immediately after extubation were significantly higher than those of group A and B, with statistical significance （P〈0.05）. VAS score of group B, C and D were significantly lower than those of group A 1, 2, 6, 12, 24 h after surgery, the group D was significantly lower than the group C, with statistical significance （P〈0.05）. The case number of supplemental analgesic drugs and ADR as dysphoria, shiver in group B, C and D were significantly lower than in group A. The radio of supplemental analgesic drugs and dysphoria in group D were significantly lower than in group C, with statistical significance （P〈0.05）. CONCLUSIONS： Parecoxib 40 mg 15 min before the end of surgery can effectively prevent the occur- rence of hyperalgesia after remifentanil hydrochloride anesthesia with good safety.