帕瑞昔布钠注射液对急性腰椎间盘突出手术患者的镇痛作用

Clinical trial of parecoxib sodium on analgesia in patients with acute lumbar disc surgery

目的观察帕瑞昔布钠注射液对急性腰椎间盘突出手术患者的镇痛疗效及对炎症因子的影响。方法 70例急性腰椎间盘突出患者随机分为试验组和对照组,每组35例。对照组术前静脉注射0.9%Na Cl 2 m L,试验组术前静脉注射帕瑞昔布钠40 mg。比较2组术后不同时间段疼痛程度和炎症因子水平,并观察2组术后药物不良反应发生情况。结果试验组术后2,5,10 h的VAS评分分别为(2.81±0.43),(3.02±0.51),(3.25±0.53)分,对照组分别为(3.78±0.46),(4.11±0.53),(4.58±0.61)分,差异有统计学意义(P<0.05)。对照组术后12 h按压镇痛泵次数为(10.32±1.22)次,试验组为(6.32±0.65)次;试验组术后24 h舒芬太尼使用量为(77.66±7.85)μg,试验组为(56.32±5.42)μg,差异有统计学意义(P<0.05)。术后10 d,试验组的超敏C反应蛋白为(5.33±0.09)mg·L^(-1),红细胞沉降率为(9.40±0.31)mm·h^(-1),白细胞介素-6为(20.67±1.85)pg·m L^(-1),白细胞介素^(-1)0为(13.20±2.05)pg·L^(-1);对照组超敏C反应蛋白为(10.28±0.55)mg·L^(-1),红细胞沉降率为(15.34±0.70)mm·h^(-1),白细胞介素-6为(37.26±2.56)pg·m L^(-1),白细胞介素^(-1)0为(7.45±1.14)pg·L^(-1)(P<0.05)。试验组出现发热和低血压各1例,恶心、呕吐和心动过速各2例,嗜睡3例,药物不良反应发生率为31.43%(11/35例)。对照组出现恶心和呕吐各3例,发热和低血压各4例,嗜睡5例,心动过速6例,药物不良反应发生率为71.43%(25/35例,P<0.05)。结论帕瑞昔布钠对急性腰椎间盘突出症患者进行术前预处理,能明显缓解患者术后疼痛感,改善炎症反应,药物不良反应发生率低。

Objective To evaluate the analgesia effect parecoxib sodium in patients with acute lumbar disc surgery, and its effect on inflammatory factor. Methods A total of 70 patients with acute lumbar disc disease were divided into treatment group and control group, 35 cases in each group. Control group was treated with intravenous 0. 9% NaCl 2 mL, treatment group was treated with parecoxib sodium 40 mg in preoperative. After surgery, the pain degree and inflammatory factor levels of the two groups at different times were compared, and the adverse drug reactions in two groups were observed. Results The visual analogue scale（VAS） in treatment group were 2.81 ±0. 43,3.02 ±0. 51,3.25 ±0. 53 at 2, 5, 10 h after surgery, had significant difference with those in control group, which were 3.78 ±0.46,4. 11 ±0.53,4.58 ±0.61（P 〈0.05）. The analgesia pump number at 12 h after surgery in control group was 10. 32 ± 1.22, thedosage of sufentanil was （77.66 ± 7.85 ） μg, had significant difference with treatment group, which were 6.32 ± 0.65, （56.32 ±5.42） μg（P 〈0. 05）. The levels of hypersensitive C -reactive protein, erythrocyte sedimentation rate, interleukins（IL） -6 and IL - 10 in treatment group at 10 d after surgery were（5.33 ±0. 09） mg.L-1 , （9.40 ±0. 31 ） mm . h-1, （20.67 ± 1.85 ） pg . mL-1, （ 13.20 _± 2.05） pg. L-1 , had significant difference with control group, which were（10. 28 ±0.55） mg . L-1,（15.34 ±0.70） mm. h-1, （37.26 ±2.56） pg . mL-1, （7.45 ±1.14） pg .L-1 （P 〈0. 05）. There were 1 case of fever, 1 case of hypotension, 2 cases of nausea, 2 cases of vomiting, 2 cases of tachycardia, 3 cases of lethargy, with the incidence rate of 31.43% （11/35 cases）. There were 3 cases of nausea, 3 cases of vomiting, 4 cases of fever, 4 cases of hypotension, 5 cases of lethargy, 6 cases of tachycardia, with the incidence rate of 71.43% （25/35 cases, P 〈 0.05 ）. Conclusion Parecoxib sodium on acute lumbar disc disease patients before surgery, can relieve postoperative pain, improve the inflammatory factors with low incidence of adverse drug reactions, promote patients recover as soon as possible.