帕瑞昔布在腹腔镜结直肠癌手术疼痛管理中的应用

Perioperative intravenous Parecoxib for pain management after laparoscopic colorectal cancer surgery

目的探讨帕瑞昔布应用于腹腔镜结直肠癌围手术期疼痛管理的镇痛效果、以及是否可减少阿片类药物使用量及相关不良反应。方法将116例拟行结直肠癌切除术患者随机分为两组，其中帕瑞昔布组59例，在麻醉诱导前15min静脉注射帕瑞昔布40mg，术后72h内每隔12小时静脉注射帕瑞昔布40mg；对照组57例，在围手术期不使用帕瑞昔布。两组患者术后48h内均通过自控镇痛泵给予阿片类药物。疼痛评分至4分以上时追加使用阿片类药物控制疼痛。结果帕瑞昔布组术后各个时间点静息、咳嗽时及活动时疼痛的视觉模拟评分均低于对照组（均P〈0．05）。两组不良反应的发生率相比差异无统计学意义（P〉0．05）。帕瑞昔布组术后住院时间比对照组短[（8．6±1．1）d比（9．2±1．4）d，P〈0．05]。术后第1天，帕瑞昔布组比对照组阿片类药物用量明显减少[0mg（0，7．5）比10mg（7．5，15），Z=2364，P=0．000]；术后5d，总吗啡用量较对照组明显减少[20mg（10，25）比42．5mg（37．5，45），Z=1770，P=0．000]。结论腹腔镜结直肠癌患者在围手术期使用帕瑞昔布能够增强静息状态、咳嗽时及活动时的镇痛效果，减少阿片类药物用量，促进术后康复，缩短住院时间。

Objective To investigate the analgesic effect of perioperatively intravenous Parecoxib for pain management after laparoscopic surgery of colorectal cancer, and whether it can reduce opioid requirements and opioid-related adverse effects. Methods 116 patients ungergoing laparoscopic colorectal resection were randomized to receive either intravenous parecoxib at a dose of 40 mg 15 minutes before induction of anesthesia followed by 40 mg every 12 hous for 72 hours （ Parecoxib Group, n = 59 ） or without the use of Parecoxib （control group, n = 57 ）. All patients had access to patient controlled analgesia （PCA） with Sufentanil within 48 hours after the operation. Patients were assessed with respect to Visual Analog Scale （VAS） from 0 - 10, and supplementary opiates were provided when VAS was above 4. Results Compared with control group, Parecoxib group had lower VAS scores at rest, while coughing and mobilization at each time point after the operation （ P 〈 0. 05 ）. There was no significant difference in the incidence of adverse reactions between the two groups （ P 〉 0.05 ）. The postoperative hospital stay was less in Parecoxib group （P 〈0. 05） , and Parecoxib group consumed less opium on post-op day 1 [0 mg（0,7.5） vs. 10 rag（7.5,15）, Z =2 364,P =0. 0001, and less total opium consumption in 5 days after surgery [20 mg （10,25） vs. 42.5 mg （37.5,45）, Z=I 770,P=0.0001. Conclusions The use of Parecoxib with PCA Sufentanil in postoperative analgesia resulted in comprehensive enhancement of the analgesic efficacy, reducing the opioid requirement, promoting postoperative recovery and shortening hospital stay.