帕瑞昔布钠对剖宫产产妇围术期凝血功能的影响

Effect of parecoxib sodium on perioperative coagulation function of parturients undergoing cesarean section

目的探究帕瑞昔布钠对剖宫产产妇围手术期凝血功能的影响。方法研究对象为2016年1月至2020年1月福建省立医院择期进行剖宫产术的66例单胎、足月产妇,均实施腰硬联合麻醉,将其按照随机数字表法分为帕瑞昔布钠组与对照组。帕瑞昔布钠组年龄(30.4±4.2)岁,体质量指数(BMI)(26.6±2.5)kg/m2;对照组年龄(30.4±5.7)岁,BMI(26.8±2.4)kg/m2。接受手术前,不能给予产妇药物,进入手术室后建立静脉通道,并对产妇的心率(HR)、平均动脉压(MAP)、心电图(ECG)、血氧饱和度(SpO2)等进行实时监护。产妇成功分娩后,帕瑞昔布钠组的产妇进行静脉注射40 mg帕瑞昔布钠,对照组产妇静脉注射等体积生理盐水。对比两组不同时间[术前(入室时)、术中(给药后30 min)、术后(给药后2 h)]的凝血四项变化及血栓弹力图(TEG)变化情况。结果帕瑞昔布钠组术中的纤维蛋白原(FIB)水平高于对照组[3.9(3.5,4.4)g/L比3.4(3.3,3.8)g/L],术中凝血酶时间(TT)水平、术后凝血酶原时间(PT)水平均低于对照组[14.5(14.2,15.2)s比15.4(14.7,16.9)s,(11.9±0.8)s比(12.6±0.9)s](均P<0.05)。帕瑞昔布钠组术中凝血形成时间(K)、血块溶解速度参数(LY30)水平低于对照组,凝固角(α)、凝血综合指数(CI)水平高于对照(均P<0.05);帕瑞昔布钠组术后凝血反应时间(R)水平低于对照组,CI水平高于对照组(均P<0.05)。结论剖宫产术中胎儿娩出断脐后单次静脉注射帕瑞昔布钠40 mg对产妇围术期凝血功能的影响不明显,可安全使用。

Objective To explore the effect of parecoxib sodium on the coagulation function of parturients during the perioperative period of cesarean section.Methods The subjects of the study were 66 singleton and full-term parturients who had elective cesarean section in Fujian Provincial Hospital from January 2016 to January 2020,all under combined spinal-epidural anesthesia.They were divided into a parecoxib sodium group and a control group with the random number table method.The parecoxib sodium group was(30.4±4.2)years old with a body mass index(BMI)of(26.6±2.5)kg/m2;the control group was(30.4±5.7)years old with a BMI of(26.8±2.4)kg/m2.Before undergoing surgery,the drugs could not be given.After entering the operating room,venous access was established,and the maternal heart rate(HR),mean arterial pressure(MAP),electrocardiogram(ECG),blood oxygen saturation(SpO2)were monitored in real time.After the parturients gave birth successfully,the parecoxib sodium group received intravenous injection with 40 mg parecoxib sodium;the control group received intravenous injection with equal volume of normal saline.The changes of blood coagulation function and thromboelastogram(TEG)in the two groups at different time points[preoperative(when entering the operating room),intraoperative(30 min after the administration),and postoperative(2 h after the administration)]were compared.Results The intraoperative fibrinogen(FIB)level of the parecoxib sodium group was higher than that of the control group[3.9(3.5,4.4)g/L vs.3.4(3.3,3.8)g/L],the intraoperative thrombin time(TT)level and postoperative prothrombin time(PT)level were lower than that of the control group[14.5(14.2,15.2)s vs.15.4(14.7,16.9)s,(11.9±0.8)s vs.(12.6±0.9)s](all P<0.05).The intraoperative levels of coagulation formation time(K)and blood clot dissolution rate parameter(LY30)in the parecoxib sodium group were lower than those in the control group,while the levels of solidification angle(α)and coagulation index(CI)were higher than those in the control group(all P<0.05).The postoperative coagulation reaction time(R)level in the parecoxib sodium group was lower than that in the control group,and the CI level was higher than that in the control group(both P<0.05).Conclusion A single intravenous injection of 40 mg parecoxib sodium after the umbilical cord is broken during cesarean section has no obvious effect on the coagulation function of parturients during the perioperative period,and it can be used safely.