帕瑞昔布对高龄结直肠癌患者术后镇痛的疗效

Use of Parecoxib on postoperative analgesia for the elderly patients undergoing colorectomy

目的观察环氧化酶．2抑制剂帕瑞昔布对高龄结直肠癌患者术后的镇痛疗效。方法选择82例75岁以上高龄患者，其中接受开腹结直肠癌根治术44例，腹腔镜结直肠癌根治术38例。开腹手术患者中有22例术后采用自控镇痛联合帕瑞昔布镇痛为观察组，22例使用自控镇痛联合安慰剂作为对照组。腹腔镜手术患者中19例使用帕瑞昔布镇痛为观察组，19例使用曲马多为对照组。结果开腹手术组中，在静息疼痛评分无差异情况下，观察组术后芬太尼平均用量为（0．45±0．23），对照组用量为（0．78±0．16）mg，差异有统计学意义（P〈0．05）。腹腔镜组中术后6、12、24、48、72h，观察组静息疼痛评分分别为（5．01±0．36）、（4．44±0．37）、（4．02±0．46）、（3．35±0．52）、（2．54±0．23）分，对照组分别为（5．86±0．45）、（5．03±0．64）、（4．89±0．75）、（3．94±0．73）、（2．56±0．41）分，差异均有统计学意义（均P〈0．01）。术后观察组平均胃肠功能恢复时间（3．1±0．7）d，对照组为（5．9±0．4）d，P〈0．01，观察组术后不良反应发生率低于对照组（P〈0．01）。结论帕瑞昔布用于高龄结直肠癌患者的术后镇痛可减少阿片类镇痛药物用量，保护患者免疫功能。

Objective To evaluate Parecoxi on postoperative analgesia for the elderly patients undering colorectomy. Methods 82 patients were randomly divided into group of 44 patients undergoing open surgery and 38 patients receiving laparoscopic colorectomy. 22 patients in open surgery using Parecoxib sodium combined with PCA analgesic way were named as observation group, while the other 22 patients using placebo combined with PCA analgesic way named as control group. 19 laparoscopic surgery patients using Parecoxib sodium analgesia were named as observation group, while the other 19 patients using Tramadol analgesia named as control group. Results In the absence of any differences of VAS pain score, in the open surgery group, the average dosage of Fentanyl in observation group was （0. 45 ± 0. 23） mg vs. （0. 78 ±0. 16）mg in observation group （P 〈 0. 05 ）. Parecoxib reduced the dosage of Fentanyl of PCA in the open surgery group. In laparoscopic group, at the time of postoperative 6, 12, 24, 48, 72 h, in the observation group patients resting pain scores were 5. 01 ±0. 36, 4.44 ＋0. 37, 4. 02 ±0.46, 3.35 ±0. 52, 2, 54 ±0. 23 respectively, while in the control group patients resting pain scores were 5.86 ±0. 45,5.03 ±0. 64, 4. 89 ＋ 0. 75, 3.94 ±0. 73, 2. 56± 0.41 respectively, （P 〈 0. 01 ）. The postoperative gastrointestinal function recovery time was （3.1 ±0.7） d in observation group vs. （5.9 ±0.4） d in the control group （P 〈0.01）. The incidence of postoperative nausea and vomiting, were lower in observation group, （ P 〈 0. 01 ） . Conclusion Parecoxib can be used for postoperative analgesia in elderly patients with colorectal cancer, reducing the dosage of opioids, and protecting the patient＇s immune function.