日间手术患者依托考昔超前镇痛疗效与安全性观察

The Safety and Validity of Etoricoxib for Pre-emptive Analgesia in Day-case Surgery

目的:观察门诊日间妇科手术患者口服依托考昔超前镇痛的疗效与安全性。方法:64例妇科门诊日间手术患者随机分为依托考昔(A)组和空白对照(B)组,各32例,ASAⅠ级。A组术前2h口服依托考昔120mg,B组术前2h口服安慰剂,两组患者麻醉方法相同,即静脉滴注芬太尼30μg和丙泊酚1~2mg/kg。术中如出现体动,酌情追加丙泊酚20~30mg。观察并记录术前、术中、术毕及术后20min MAP、HR、RR、SpO_2、麻醉时间、手术时间、苏醒(自末次给药至呼之睁眼)时间及出血量、恶心、呕吐等不良反应情况。观察并评价患者术后2min、5min、10min、30min、1h及电话随访术后4h、8h、12h及24h疼痛情况,视觉模拟评分(VAS)法评估术后疼痛。患者手术前、术后30min均进行徒手平衡试验评价患者跌倒指数,正常后方可离院。结果:A组术后10min、30min、1h、4h、8h、12h镇痛效果明显,与B组比较差异有统计学意义(P<0.01);两组在围手术期生命体征及苏醒时间、术中出血量比较差异无统计学意义(P>0.05);所有患者均无不良反应发生。结论:门诊日间妇科手术患者术前口服依托考昔超前镇痛安全、有效,可显著延长术后镇痛持续时间。

Objective： To observe safety and validity of etoricoxib for pre-emptive analgesia in day-case surgery. Methods： 64 outpatients,ASA gradeⅠ,Scheduled for gynecological surgery at clinic, were enrolled in the study.They were allocated randomly into group A（ n =32）, treatment group, who were given etoricoxib 120mg orally two hours prior to the operation, and group B（ n =32）,control group, who were given similar looking placebos pre-operation. All of the patients received the same anesthesia with 30μg of fentanyl and 1~2mg/kg of propofol intravenous injection subsequently. Operation started after the patient fell asleep.20~30mg of propofol was discretionarily supplemented intravenously if patient’s movement occurred at any time during the operation.Patient’s vital signs,including HR,MAP,SpO 2,respiratory frequency, were observed and recorded at pre and peri-operation,immediate at the end of procedure and 20 minutes post-operatively. Anesthesia duration,duration of operation lasted,awakening time （from the latest administration to eye opening by calling） and also blood loss,some of the untoward effects,such as nausea and vomiting recorded.Painful state was assessed with VAS at 2 minutes,5 minutes,10 minutes,30 minutes,1 hour postoperatively.Visual analog score at 4 hours,8 hours,12 hours,and 24 hours was got through telephone interview after the operations.Patient was allowed to leave after the Fall Risk Index was evaluated by unarmed balancing test both pre-operation and 30min post-operation. Results： There was a significant analgesic effect in group A at 10 hours,30 hours,1 hour,4 hours,8 hours and 12 hours post-operatively to compared to group B at the same timepoint（ P 〈0.01）.Vital signs,recovery time, even blood loss during the procedure were no difference between the two groups,and there was no adverse effects found in all of the patients. Conclusion： Etoricoxib was given to unhos-pitalized patient orally for pre-emptive before day-case surgery was much effectiveness and safety,which can prolong postoperative analgesic duration significantly