帕瑞昔布钠联合芬太尼对结直肠癌腹腔镜根治术后疼痛及应激反应的影响

Effect of parecoxib sodium combined with fentanyl on analgesia and stress response after laparoscopic radical resection of colorectal cancer

目的:探讨帕瑞昔布钠联合芬太尼对结直肠癌腹腔镜根治术后镇痛及对应激反应的影响。方法:抽取于2017年1月至2019年12月于河南医学高等专科学校附属医院行腹腔镜根治术的结直肠癌患者94例,依据随机数字表法分为观察组与对照组,每组47例。观察组于麻醉诱导前30 min静脉注射40 mg帕瑞昔布钠,对照组于麻醉诱导前30 min静脉注射5 ml生理氯化钠溶液。术后两组均采用芬太尼静脉自控镇痛。比较两组手术时间和术中出血量,术后3、12、24 h视觉模拟评分法(VAS)评分,术前1 d和术后24 h应激反应变化及不良反应发生情况。结果:两组手术时间和术中出血量比较差异未见统计学意义(P>0.05)。观察组术后3、12、24 h VAS评分低于对照组(P<0.05)。两组术后24 h血清去甲肾上腺素(NE)、白细胞介素-6(IL-6)和皮质醇(COR)水平较术前1 d升高(P<0.05);观察组术后24 h血清NE、IL-6和COR水平低于对照组(P<0.05)。两组不良反应比较差异未见统计学意义(P>0.05)。结论:帕瑞昔布钠联合芬太尼对结直肠癌腹腔镜根治术后镇痛效果明显,且对应激反应影响小。

Objective To investigate the analgesic effect of parecoxib sodium combined with fentanyl after laparoscopic radical resection of colorectal cancer and its effect on stress response.Methods The 94 patients with colorectal cancer who underwent laparoscopic radical surgery in Affiliated Hospital of Henan Medical College from January 2017 to December 2019 were divided into observation group(47 cases)and control group(47 cases)based on random digital.In the observation group,40 mg of parecoxib sodium was intravenously injected 30 minutes before anesthesia induction,and in the control group,5 ml of normal saline was intravenously injected 30 minutes before anesthesia induction.Fentanyl was used in both groups.The operation time,intraoperative hemorrhage,postoperative 3 hours,postoperative 12 hours and postoperative 24 hours visual analogue score(VAS)were compared between the two groups.Results There was no significant difference between the two groups in operation time and bleeding volume(P>0.05).The postoperative 3 h,12 h and 24 h VAS scores in the observation group lower than those in the control group(P<0.05).The postoperative 24 h levels of serum noradrenaline(NE),interleukin-6(IL-6)and cortisol(COR)in the two groups were higher than those in the first day of preoperation(P<0.05);the postoperative 24 h levels of serum NE,IL-6 and COR in the observation group were lower than those in the control group(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusions Parecoxib sodium combined with fentanyl has obvious analgesic effect and little effect on stress response.