帕瑞昔布钠联合右美托咪定预防腹部闭合性损伤手术患者苏醒期躁动

Clinical observation of emergence agitation of parecoxib sodium combined with dexmedetomidine on patients undergoing closed abdominal injury surgery

目的探讨帕瑞昔布钠单独或联合右美托咪定用于预防腹部闭合性损伤手术患者苏醒期躁动(emergence agitation,EA)的效果及对炎性因子的影响。方法选全麻下行腹部闭合性损伤开放手术患者125例,最终帕瑞昔布钠联合右美托咪定组(PD组)41例、帕瑞昔布钠组(P组)45例、生理盐水组(C组)39例。PD组、P组、C组分别于手术结束前30 min静脉滴注右美托咪定+帕瑞昔布钠、帕瑞昔布钠及等量生理盐水。观察EA发生率,呼吸恢复时间、苏醒时间、拔管时间、血流动力学指标、炎性因子水平。结果(1)PD组、P组EA发生率显著低于C组;PD组Ramsay镇静评分显著高于P组、C组,Riker镇静躁动评分、PARD评分显著低于P组、C组;(2)3组呼吸恢复时间、苏醒时间、拔管时间比较差异无统计学意义;(3)T1、T2时PD组、P组MAP、HR显著低于C组;(4)PD组、P组T1、T2时血清TNF-1α、IL-6显著低于C组,IL-10水平显著高于C组。结论腹部闭合性损伤全麻术中帕瑞昔布钠单用或与右美托咪定联用均能预防EA发生,呼吸恢复、苏醒时间及拔管时间未见明显延长,血流动力学指标稳定,对炎症反应有一定抑制作用,且联合用药效果优于单用。

Objective To investigate the effect of parecoxib sodium alone or in combination with dexmedetomidine in preventing emergence agitation(emergence agitation,EA)in patients undergoing closed abdominal injury surgery and its influence on inflammatory factors.Methods 125 patients with closed abdominal injury underwent opensurgery under general anesthesia were selected,they were divided into parecoxib sodium combined with dextropyrimidine group(PD group,41 cases),parecoxib sodium group(P group,45 cases)and saline group(C group,39 cases).The subjects in the PD group,P group,C group were injected with dexmedetomidine+parecoxib sodium,parecoxib sodium and equal saline 30 minutes before the end of operation respectively.The incidence of EA,recovery time of breathing,recovery time,extubation time,hemodynamic parameters and inflammatory factorslevel were observed.Results(1)The incidence of EA in PD group,P group was significantly lower than that in C group,Ramsay sedation score in PD group was significantly higher than that in P group,C group,Riker sedation and restlessness score and PARD score were significantly lower than those in P group,C group.(2)There was no significant difference in respiratory recovery time,recovery time and extubation time among the three groups.(3)At T1 and T2,MAP and HR in PD group,P groups were significantly lower than those in C group.(4)Serum TNF-1αand IL-6 levels in PD group,P groups at T1 and T2 were significantly lower than those in C group,and IL-10 levels were significantly higher than those in C group.Conclusion During general anesthesia for closed abdominal injury,parecoxib sodium alone or in combination with dexmedetomidine can prevent EA,respiratory recovery,recovery time and extubation time have not been significantly prolonged,hemodynamic parameters are stable and inflammation reaction has been inhibited.And the effects of combined use are better than that of single use.