腰椎间盘突出症经皮椎间孔镜手术麻醉诱导前应用帕瑞昔布钠超前镇痛的临床研究

Clinical study of preemptive analgesia with parecoxib sodium before anesthesia induction in percutaneous foraminoscopic surgery for lumbar disc herniation

目的探讨在腰椎间盘突出症经皮椎间孔镜手术麻醉诱导前应用帕瑞昔布钠超前镇痛的临床效果。方法选取70例行经皮椎间孔镜手术治疗的腰椎间盘突出症患者纳入研究,随机分为观察组及对照组,每组35例。对照组予以常规麻醉镇痛,观察组采用帕瑞昔布钠超前镇痛。比较两组患者术中不同时间[切皮时(T1)、分离肌肉韧带时(T2)、对神经根进行刺激时(T3)、缝皮时(T4)]的血流动力学指标[心率(HR)、平均动脉压(MAP)]水平,术后不同时间(术后2、6、12、24 h)的视觉模拟评分法(VAS)评分,术后不良反应发生率。结果两组T2、T3、T4时的HR、MAP水平均低于T1时,且观察组T1、T2、T3、T4时的HR水平分别为(79.63±8.26)、(75.68±7.55)、(72.17±6.49)、(70.04±5.07)次/min,低于对照组的(84.15±8.49)、(80.31±7.44)、(78.65±6.58)、(75.41±6.19)次/min,MAP水平分别为(85.44±10.43)、(77.33±10.12)、(78.65±9.88)、(79.86±9.53)mm Hg(1 mm Hg=0.133 kPa),高于对照组的(79.22±10.66)、(71.51±10.39)、(73.21±8.57)、(74.57±8.46)mm Hg(P<0.05)。观察组术后2、6、12、24 h的VAS评分分别为(2.26±0.46)、(2.86±0.68)、(3.16±0.77)、(3.79±0.94)分,低于对照组的(2.79±0.58)、(3.46±0.79)、(3.76±0.91)、(4.27±0.89)分(P<0.05)。观察组术后不良反应发生率(20.00%)高于对照组(11.43%),但差异无统计学意义(P>0.05)。结论将帕瑞昔布钠超前镇痛应用于腰椎间盘突出症患者经皮椎间孔镜手术麻醉诱导前可改善术中血流动力学,亦能有效降低术后疼痛程度,该方案安全性良好,有利于预后康复。

Objective To explore th e clinical effect of preemptive analgesia with parecoxib sodium before anesthesia induction in percutaneous foraminoscopic surgery for lumbar disc herniation.Methods 70 patients with lumbar disc herniation who underwent percutaneous foraminoscopic surgery were included in the study,and the selected patients were randomly divided into an observation group and a control group,with 35 cases in each group.The control group was given conventional anesthesia and analgesia,and the observation group was given preemptive analgesia with parecoxib sodium.Both groups were compared in terms of hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]at different times[during skin cutting(T1),separation of muscle and ligament(T2),stimulation of nerve roots(T3),and suturing(T4)],visual analogue scale(VAS)score at different time(2,6,12,24 h postoperatively)and incidence of postoperative adverse reactions after surgery.Results HR and MAP levels at T2,T3 and T4 were lower than those that T1;at T1,T2,T3 and T4,HR levels were(79.63±8.26),(75.68±7.55),(72.17±6.49)and(70.04±5.07)beats/min in the observation group,which were lower than(84.15±8.49),(80.31±7.44),(78.65±6.58)and(75.41±6.19)beats/min in the control group;MAP levels were(85.44±10.43),(77.33±10.12),(78.65±9.88)and(79.86±9.53)mm Hg(1 mm Hg=0.133 kPa)in the observation group,which were higher than(79.22±10.66),(71.51±10.39),(73.21±8.57)and(74.57±8.46)mm Hg in the control group(P<0.05).The VAS scores of the observation group at 2,6,12 and 24 h postoperatively were(2.26±0.46),(2.86±0.68),(3.16±0.77)and(3.79±0.94)points,which were lower than(2.79±0.58),(3.46±0.79),(3.76±0.91)and(4.27±0.89)points of the control group(P<0.05).The incidence of postoperative adverse reactions in the observation group(20.00%)was higher than that in the control group(11.43%),but the difference was not statistically significant(P>0.05).Conclusion Preemptive analgesia with parecoxib sodium in patients with lumbar disc herniation can improve intraoperative hemodynamics and effectively reduce postoperative pain before anesthesia induction in percutaneous foraminoscopic surgery.This program is safe and conducive to prognosis and rehabilitation.