右美托咪定复合帕瑞昔布钠对腹腔镜阑尾切除术后疼痛的影响

Effect of dexmedetomidine combined with parecoxib sodium on pain after laparoscopic appendectomy

目的观察右美托咪定复合帕瑞昔布钠对腹腔镜阑尾切除术后疼痛的影响。方法选取江苏盛泽医院2020年4—12月在腹腔镜下行阑尾切除术的患者90例,随机分为三组:右美托咪定复合帕瑞昔布钠组(A组)、帕瑞昔布钠组(B组)和对照组(C组),每组各30例。麻醉诱导前30 min,A组静脉泵注右美托咪定0.6μg/kg(15 min输注完)复合静脉注射帕瑞昔布钠40 mg;B组静脉注射帕瑞昔布钠40 mg;C组为空白对照组。观察并记录入室后(T0)、气管插管时(T1)、气腹5 min(T2)、气腹30 min(T3)、拔管时(T4)的平均动脉压(MAP)和心率(HR),术毕记录手术时间、拔管时间,以及恶心、呕吐、躁动、寒战等不良反应发生情况。评估并记录术后6 h(T5)、12 h(T6)、24 h(T7)的疼痛数字等级评分(NRS评分)以及Ramsay镇静评分。结果T5~T7时A组和B组的NRS评分明显降低且低于C组,差异有统计学意义(P<0.05);T5~T7时A组NRS评分低于B组,差异有统计学意义(P<0.05)。A组0例、B组3例、C组7例NRS评分>6分,A组镇痛药物追加例数明显低于B组和C组,差异有统计学意义(P<0.05)。T5时A组的Ramsay评分高于B组和C组(P<0.05),T6~T7时三组Ramsay评分、患者恶心、呕吐发生率比较,差异无统计学意义(P>0.05);A组和B组的躁动与寒战发生率低于C组(P<0.05);但A组患者躁动与寒战发生率低于B组,差异有统计学意义(P<0.05)。结论与单用帕瑞昔布钠相比,麻醉诱导前30 min静脉泵注右美托咪定0.6μg/kg复合静脉注射帕瑞昔布钠40 mg镇痛效果较优,躁动与寒战发生率较低。

Objective To observe the effect of dexmedetomidine combined with parecoxib sodium on pain after laparoscopic appendectomy.Methods A total of 90 patients who underwent laparoscopic appendectomy from April to December 2020 in Jiangsu Shengze Hospital were selected and randomly divided into three groups:the dexmedetomidine combined with parecoxib sodium group(group A),the parecoxib sodium group(group B)and the control group(group C),with 30 cases in each group.30 minutes before induction of anesthesia,patients in group A were intravenously injected with 0.6μg/kg dexmedetomidine(with a infusion completion time of 15 min)and 40 mg parecoxib sodium,while patients in group B were intravenously injected with 40 mg parecoxib sodium,and group C was taken as a blank control group.The mean arterial pressure(MAP)and heart rate(HR)were observed and recorded at the time of entering the operation room(T0),tracheal intubation(T1),5 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),and extubation(T4).The operating time,extubation time,and the incidences of adverse reactions such as nausea,vomiting,agitation,chills were recorded at the end of the operation.In addition,the scores of Numerical Rating Scale(NRS)and Ramsay sedation scores were recorded at 6 h(T5),12 h(T6)and 24 h(T7)after operation.Results The NRS scores in group A and group B were significantly lower than that of group C from T5 to T7(P<0.05).Meanwhile,the NRS scores in group A were significantly lower than that of group B from T5 to T7(P<0.05).0 cases in group A,3 cases in group B and 7 cases in group C with NRS score>6,and the number of cases of additional analgesic drugs in group A was significantly lower than that in group B and group C(P<0.05).The Ramsay scores in group A were significantly higher than those in group B and group C at T5(P<0.05),and there were no statistically significant differences among the three groups in the Ramsay scores,incidence of nausea and vomiting(P>0.05).The incidence of agitation and chills in group A and group B was significantly lower than that of group C(P<0.05).Meanwhile,the incidence of agitation and chills was lower in group A than that in the group B(P<0.05).Conclusion Compared with parecoxib sodium alone,the analgesic effect of combination injection of 0.6μg/kg dexmedetomidine and 40 mg parecoxib sodium 30 min before induction of anesthesia is better,and the incidence of agitation and chills is also lower.