氢吗啡酮联合帕瑞昔布钠对合并冠心病行非心脏胸部手术患者镇痛效果的影响

Effects of Hydromorphone combined with Parecoxib Sodium on analgesia in patients with coronary heart disease undergoing non-cardiac thoracic surgery

目的 探讨氢吗啡酮联合帕瑞昔布钠对合并冠心病行非心脏胸部手术患者镇痛效果的影响。方法 选取2020年9月至2022年9月浙江中医药大学附属杭州市中医院138例合并冠心病行非心脏手术患者,按照随机数字表法将其分为A组、B组、C组,各46例。三组均在全麻下进行手术,A组给予氢吗啡酮+帕瑞昔布钠,B组给予帕瑞昔布钠,C组给予氢吗啡酮。比较三组拔管前5 min(T_(0))、拔管即刻(T_(1))、拔管后5 min(T_(2))、拔管后10 min(T_(3))平均动脉压(MAP)、心率(HR)、呼吸频率(RR);比较三组术后4、12、24、72 h咳嗽时、静息时视觉模拟评分法(VAS)评分;比较三组术后24 h患者自控静脉镇痛(PCIA)有效按压次数;比较三组术前、术后12 h、术后72 h前列腺素E_(2)(PGE_(2))、神经肽Y(NPY)、肾上腺皮质激素(ACTH)、醛固酮(ALD)、C-肽(C-P);记录不良反应发生情况。结果 整体比较:三组MAP、HR、RR组间、时间、交互作用比较,差异有统计学意义(P<0.05)。进一步两两比较,组内比较:T_(1)~T_(3)时,三组MAP、HR高于T_(0)时,RR低于T_(0)时,差异有统计学意义(P<0.05)。组间比较:T_(1)~T_(3)时,A组MAP、HR低于B、C组,RR高于B、C组,差异有统计学意义(P<0.05)。整体比较:三组咳嗽时、静息时VAS评分组间、时间、交互作用比较,差异有统计学意义(P<0.05);进一步两两比较,组内比较:术后12、48、72 h,三组咳嗽时、静息时VAS评分低于术后4 h,差异有统计学意义(P<0.05);组间比较:术后4、12 h,A组咳嗽时、静息时VAS评分低于B、C组,差异有统计学意义(P<0.05)。A组术后24 h PCIA有效按压次数低于B组、C组,差异有统计学意义(P<0.05)。整体比较:三组PGE_(2)、NPY、ALD、C-P、ACTH水平组间、时间、交互作用比较,差异有统计学意义(P<0.05);进一步两两比较,组内比较:术后12 h,三组PGE_(2)、NPY、ALD、C-P、ACTH水平高于术前,差异有统计学意义(P<0.05);组间比较:术后12 h,A组PGE_(2)、NPY、ALD、C-P、ACTH水平低于B、C组,差异有统计学意义(P<0.05)。A组与B组不良反应总发生率比较,差异无统计学意义(P>0.05);A组与C组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 氢吗啡酮联合帕瑞昔布钠可缓解合并冠心病行非心脏手术患者术后疼痛感,调节内分泌、循环功能,且安全性高。

Objective To investigate the effects of Hydromorphone combined with Parecoxib Sodium on analgesia in patients with coronary heart disease undergoing non-cardiac thoracic surgery.Methods A total of 138 patients with coronary heart disease who underwent non-cardiac thoracic surgery in Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from September 2020 to September 2022 were selected,and they were divided into group A,group B,and group C using random number table method,with 46 patients in each group.All three groups underwent surgery under general anesthesia,group A was given Hydromorphone combined with Parecoxib Sodium,group B was given Parecoxib Sodium,and group C was given Hydromorphone.The mean arterial pressure (MAP),heart rate (HR),and respiratory rate (RR) among three groups were compared 5 min before extubation (T_0),immediately after extubation (T_1),5 min after extubation (T_2),and 10 min after extubation (T_3);visual analogue scale (VAS) scores were compared at 4,12,24 h,and 72 h after surgery among three groups;the effective compression times of patient-controlled intravenous analgesia (PCIA) 24 h after surgery were compared among three groups;Prostaglandin E_2(PGE_2),neuropeptide Y (NPY),adrenocortical hormone (ACTH),aldosterone (ALD),and C-peptide (C-P)were compared before surgery and 12,72 h after surgery among three groups;and the occurrence of adverse reactions among three groups were recorded.Results Overall comparison:there were statistically significant differences between groups,time,and interaction of MAP,HR,and RR among three groups (P<0.05).Further pairwise comparison,intra-group comparison:at T_1-T_3,MAP and HR among three groups were higher than those at T_0,and RR was lower than that at T_0,and the differences were statistically significant (P<0.05).Comparison between groups:at T_1-T_3,MAP and HR in group A were lower than those in group B and group C,and RR was higher than those in group B and group C,and the differences were statistically significant (P<0.05).Overall comparison:there were statistically significant differences between groups,time,and interaction of VAS at cough and rest among three groups (P<0.05);further pairwise comparison,intra-group comparison:12,48 h,and 72 h after surgery,the VAS scores at cough and rest among three groups were lower than those at4 h after surgery,and the differences were statistically significant (P<0.05);comparison between groups:4,12 h after surgery,VAS scores at cough and rest in group A were lower than those in group B and group C,and the differences were statistically significant (P<0.05).The compression times of PCIA 24 h after surgery in group A was lower than that in group B and group C,and the differences were statistically significant (P<0.05).Overall comparison:there were statistically significant differences between groups,time,and interaction of the levels of PGE_2,NPY,ALD,C-P,and ACTH among three groups (P<0.05);further pairwise comparison,intra-group comparison:12 h after surgery,the levels of PGE_2,NPY,ALD,C-P,and ACTH among three groups were higher than those before surgery,and the differences were statistically significant(P<0.05);comparison between groups:12 h after surgery,the levels of PGE_2,NPY,ALD,C-P,and ACTH in group A were lower than those in group B and group C,and the differences were statistically significant (P<0.05).There was no significant difference in the total incidence of adverse reactions between group A and group B (P>0.05);there was no significant difference in the total incidence of adverse reactions between group A and group C (P>0.05).Conclusion Hydromorphone combined with Parecoxib Sodium can relieve postoperative pain in patients with coronary heart disease undergoing non-cardiac thoracic surgery,regulate endocrine and circulatory function,and have high safety.