帕瑞昔布钠预先给药对腹部手术时肠系膜牵拉综合征的影响

Effect of pretreatment with parecoxib sodium on mesenteric traction syndrome during abdominal surgery

目的评价帕瑞昔布钠预先给药对腹部手术时肠系膜牵拉综合征的影响。方法选取我院2017年1～10月择期全麻下开腹胃肠道手术患者60例。采用随机数字表法分为两组(n=30):帕瑞昔布钠组(P组)和生理盐水组(NS组)。P组麻醉诱导时静脉注射帕瑞昔布钠40 mg,NS组静脉注射等容量的生理盐水。分别于麻醉诱导即刻(T0)、肠系膜牵拉即刻(T1)、肠系膜牵拉后10 min(T2)、肠系膜牵拉后15 min(T3)和肠系膜牵拉后30 min(T4)时,监测血流动力学参数,采集动脉血样,采用ELISA法检测血浆6-酮-前列腺素F1α(6-keto-PGF1α)浓度。结果NS组和P组在T0～T4时各血流动力学参数MAP和血浆6-keto-PGF1α比较差异无统计学意义(P>0.05);与P组比较,在T0和T1时,NS组HR差异有统计学意义(P<0.05),而T2～T4时差异无统计学意义(P>0.05);根据改良的肠系膜牵拉综合征Koyama’s分级,与P组比较,生理盐水NS组在T2、T3和T4肠系膜牵拉综合征发生差异无统计学意义(P>0.05)。结论肠系膜牵拉综合征在牵拉肠系膜后10～15 min时最显著;帕瑞昔布钠预先给药不能有效减轻肠系膜牵拉综合征的发生。

Objective To evaluate the effect of pretreatment with parecoxib sodium on mesenteric traction syndrome during abdominal surgery.Methods 60 patients with open gastrointestinal surgery under general anesthesia from January 2017 to October 2017 were selected.The patients were divided into 2 groups(n=30 cases)by random number table method,including parecoxib sodium group(group P)and saline group(group NS).In group P,anesthesia was induced by intravenous injection of parecoxib sodium 40 mg,and the group NS was intravenously injected with an equal volume of normal saline.Hemodynamic parameters were monitored,arterial blood samples were collected,and plasma 6-keto-prostaglandin F1α(6-keto-PGF1α)concentration was measured by ELISA immediately after induction of anesthesia(T0),immediate mesenteric traction(T1),10 min after mesenteric traction(T2),15 min after mesenteric traction(T3),and 30 min(T4)after mesenteric traction.Results There were no significant differences in the hemodynamic parameters MAP and plasma 6-keto-PGF1αbetween group NS and group P at T0-T4(P >0.05).There was a statistically significant difference in HR between the NS group and group P at T0 and T1(P<0.05),but there was no significant difference at T2-T4(P >0.05).According to the improved mesenteric traction syndrome Koyama's classification,there was no significant difference in the mesenteric traction syndrome between the group P and the group NS at T2,T3 and T4(P >0.05).Conclusion Mesenteric traction syndrome is most prominent at 10 to 15 minutes after pulling the mesentery;pre-administration of parecoxib sodium can not effectively reduce the occurrence of mesenteric traction syndrome.