帕瑞昔布超前镇痛替代阿片类在混合痔术后早期疼痛管理中应用的可行性研究

The feasibility study of substituting parecoxib for opioid as preemptive analgesia medicine in the early postoperative analgesia of mixed hemorrhoid

目的探讨高选择性COX-2抑制剂帕瑞昔布超前镇痛替代阿片类在混合痔术后早期疼痛管理中应用的可行性。方法选择2015年11月至2016年3月在本院住院并接受PPH+外痔切除术的环状混合痔患者90例,随机分配至3组,分别于麻醉前给予阿片类药物(A组)、高选择性COX-2抑制剂(B组),安慰剂(C组),术后采用视觉模拟评分(Visual Analogue Scale,VAS)评估各组疼痛程度及术后24小时内患者对镇痛满意度整体评价,并比较各组不良反应。结果 A组与C组相比,术后3、9小时VAS值都低于C组,差异有统计学意义(P=0.001,P=0.002);B组与C组相比,术后3、9、24小时VAS值都低于C组,差异有统计学意义(P=0.001,P=0.000,P=0.002);B组与A组相比,术后3小时至术后18小时VAS值相差无统计学意义;术后24小时,B组VAS值低于A组,差异有统计学意义(P=0.01)。各组哌替啶使用总量B组最少,仅7.5±18.32mg,A组最多,差异均有统计学意义;B组24小时整体评价优于A、C组(P分别为0.029,0.000)。A、C组各出现2例、1例恶心呕吐;B组出现1例胃部不适,无恶心呕吐;3组不良反应差异无统计学意义(P=0.765)。结论在混合痔术后早期镇痛中,高选择性COX-2抑制剂帕瑞昔布超前镇痛与阿片类相比镇痛效果相当,不良反应少,具备替代阿片类药物使用的可行性。

Objective To investigate the feasibility of replacing opioid analgesia by high selective COX-2 inhibitors parecoxib as preemptiveanalgesia medicine in mixed hemorrhoid early postoperative pain management. Methods From November 2015 to March 2016,a total of 90patients with circumferential mixed hemorrhoid hospitalized in our hospital who has been treated with stapled haemorrhoidectomy and externalhemorrhoid excision were Randomly divided into 3 groups,30 in each group.Patients were gave opioids before anesthesia in group A, high selectiveCOX-2 inhibitors in group B and placebos in group C . The patients＇ pain degree and overall evaluation of the satisfaction about the analgesia within24 hours postoperatively were assessed by Visual Analogue Scale （VAS）.The adverse reactions of each group were compared. Results The VASvalues in3 hours and 9 hours postoperatively of groupA were lower than that of group C,the difference was statistically significant （P=0.001, P=0.002）. The VAS values in3 hours,9 hours and 24 hours postoperatively of group B were lower than that of group C, the difference was statisticallysignificant（P=0.001, P=0.000, P=0.002）. The difference of the VAS values from 3 hours to 18 hours postoperatively between group A and group B wasnot statistically significant. The VAS value in 24 hours postoperatively of group B was lower than that of group A, the difference was statisticallysignificant （P=0.01）. The usage amount of pethidine in group B was the least, only （7.5±18.32）mg, and in group A was the most, the difference wasstatistically significant. The overall evaluation in 24 hours postoperatively of group B was better than that of group A and group C（P=0.029, P=0.000）.There were 2 cases of nausea and vomiting in group A, 1 case in group C, 0 case in group B, and1 case of stomach upset in group B. The differenceof the adverse reaction in the 3 groups was not statistically significant （P=0.765）. Conclusion Compared with opioid, the high selective COX-2inhibitors parecoxib has equal analgesic effect and less adverse reaction as preemptive analgesia medicine in the early postoperative analgesia ofmixed hemorrhoid. There is feasibility of the substitute for opioid.