帕瑞昔布钠联合舒芬太尼对乳腺癌根治术患者血流动力学及应激反应的影响

Effects of parecoxib sodium combined with sufentanil on hemodynamics and stress indexes in patients undergoing radical mastectomy

目的:探讨帕瑞昔布钠联合舒芬太尼对乳腺癌根治术患者血流动力学和应激指标的影响。方法:在全麻下行乳腺癌改良根治术的女性患者100例,随机分为对照组和观察组,每组各50例。对照组在麻醉诱导后给予静脉滴注生理盐水;观察组则在麻醉诱导后静滴帕瑞昔布钠,术后两组均采用患者静脉自控镇痛(PCIA)。分别比较两组患者不同时间点视觉模拟评分(VAS)、简明精神状态量表评分(MMSE)、血流动力学和应激指标及治疗期间不良反应发生情况等。结果:手术后,两组患者VAS评分均显著下降,且观察组术后2 h、12 h评分均低于对照组(P<0.05),但两组术后24 h的VAS评分差异无统计学意义;与对照组相比,观察组术后2 h、12 h按压镇痛泵次数及舒芬太尼总消耗量均明显下降(P<0.05);观察组患者术后MMSE评分明显高于对照组(P<0.05);观察组患者拔管后10 min(T2)、15 min(T3)、30 min(T4)的平均动脉压、心率均低于对照组(P<0.05);两组患者皮质醇、肾上腺素及去甲肾上腺素水平在术后各时间点均显著升高(P<0.05)。观察组皮质醇和去甲肾上腺素水平在术后6、12、24 h较显著低于对照组,肾上腺素水平在术后12 h、24 h显著低于对照组(P<0.05)。结论:帕瑞昔布钠联合舒芬太尼用于乳腺癌根治术,可有效维持血流动力学稳定、缩短麻醉恢复时间、降低应激反应和不良反应发生率。

Objective:To observe the effects of parecoxib sodium combined with sufentanil on hemodynamics and stress indexes in patients undergoing radical mastectomy.Methods:100 female patients undergoing radical mastectomy with general anesthesia were enrolled.All patients were divided into observation group and control group according to a random number table method,50 cases in each group.In the control group,the saline was given intravenously after induction of anesthesia.In the observation group,parecoxib sodium was intravenously administered in the same manner after induction of anesthesia.Intravenous patient-controlled analgesia(PCIA)was applied in all patients.The visual analogue score(VAS),MMSE,hemodynamics,stress index and adverse reactions during treatment were compared between the two groups.Results:After operation,the VAS scores of the two groups decreased significantly,and the scores of the observation group at 2 h and 12 h after operation were lower than those of the control group(P<0.05),but there was no significant difference between the two groups at 24 h after operation.Compared with the control group,the times of pressing the analgesia pump and the total consumption of sufentanil in the observation group decreased significantly at 2 h and 12 h after operation(P<0.05).The MMSE scores in the observation group were markedly increased than that in the control group(P<0.05).The MAP and HR in the observation group were lower than those of the control group in 10 min to 30 min after extubation(P<0.05).The levels of cortisol and norepinephrine in the observation group were lower than those in the control group at 6 h,12 h and 24 h after operation,and the levels of epinephrine were lower than those in the control group at 12 h and 24 h after operation(P<0.05).Conclusion:Parecoxib sodium combined with sufentanil in patients with modified radical mastectomy can be more effective to maintain hemodynamic stability,shorten the recovery time from anesthesia,reduce the incidence of stress and adverse reactions.