预注帕瑞昔布钠对高龄直肠癌根治术患者麻醉苏醒期躁动的影响

Effect of pretreatment with parecoxib sodium on emergence agitation during recovery from anesthesia in elderly patients undergoing radical resection of rectal cancer

目的探讨预注帕瑞昔布钠对直肠癌根治术高龄患者麻醉苏醒期躁动的影响。方法将金华市中心医院2014年1月—2016年10月收治的72例实施直肠癌根治术高龄患者随机分为2组,观察组:于麻醉诱导前静脉注射帕瑞昔布钠0.6 mg/kg;对照组:于麻醉诱导前静脉注射等剂量生理盐水。后均静注0.3 mg长托宁、0.05mg/kg咪达唑仑、3μg/kg芬太尼、1.0~1.5 mg/kg丙泊酚、1 mg/kg阿曲库铵行麻醉诱导,气管内导管置入成功后给予丙泊酚泵注及间断静注芬太尼、顺-阿曲库铵维持脑电双频指数(BIS)于40~60之间,缝合皮肤时停止泵注药物。记录2组患者手术一般情况并比较拔管时间、苏醒时间及麻醉苏醒室(PACU)停留时间、不同时刻血流动力学指标、苏醒期躁动情况、PARD评分及不良反应发生率。结果观察组麻醉苏醒室停留时间低于对照组(P<0.05),但2组患者拔管时间、苏醒时间比较差异无统计学意义(P>0.05);观察组T2、T3时刻平均动脉压(MAP)及心率(HR)水平均低于对照组,且对照组T2、T3时刻MAP及HR水平均高于T0时刻(P<0.05),但T0、T1、T4时刻2组MAP及HR水平比较差异无统计学意义(均P>0.05);观察组PARD评分、躁动发生率及不良反应发生率均低于对照组(均P<0.05)。但不良反应发生率差异无统计学意义(P>0.05)。结论预注帕瑞昔布钠可降低直肠癌根治术高龄患者麻醉苏醒期躁动及不良反应发生率,且血流动力学平稳,安全性较佳。

Objective To investigate the effect of pretreatment with parecoxib sodium on emergence agitation during re- covery from anesthesia in elderly patients undergoing radical resection of rectal cancer. Methods Seventy-two elderly pa- tients undergoing radical resection of rectal cancer in Jinhua Central Hospital from January,2014 to October,2016 were randomly divided into observation group and control group. Intravenous injection of 0.6 mg/kg parecoxib sodium was per- formed in the patients of observation group, while isodose saline for the patients of control group. The intravenous 0.3 mg, 0.05 mg/kg midazolam,fentanyl of 3 penehyclidine hydrochloride g/kg, （1 -1.5 ） mg/kg of propofol, 1 mg/kg atracuri- um was administrated in both groups for anesthesia induction. After successful endotracheal tube（ET） placement, propofol via an infusion pump, and intermittent intravenous fentanyl and CIS atracurium to maintain the EEG double frequency in- dex （BIS） at 40 - 60 until the skin was sutured. The general condition, time to extubation, recovery time, stay in post anes- thesia care unit （PACU）, hemodynamics at each time points, and emergence agitation during recovery from anesthesia, PARD score and the incidence of adverse reactions were compared between the two groups. Results The stay in PACU of the observation group was shorter than that of the control group（P 〈 0.05 ） ,however,there were no significant difference in the time to extubation and recovery（ P 〉 0.05 ） ;the MAP and HR levels at T2 and T3 of the observation group were lower than those of the control group;in the control group, MAP and HR levels at T2 and T3 were lower than that at TO （ P 〈 0.05 ）. The levels of MAP and HR at TO, T1 had no statistical significance between the two groups （ P 〉 0.05 ） ; PARD score, incidence of agitation and adverse reaction of the observation group were lower than those of the control group （ P 〈 0.05）. Conclusion The pretreatment with parecoxib sodium can reduce the incidence rate of agitation and adverse reaction,and maintain the stable hemodynamics with a better safety elderly patients undergoing radical resection of rectal cancer.