帕瑞昔布钠联合曲马多改善开胸手术后舒芬太尼静脉自控镇痛效果  

Parecoxib Sodium Combining with Tramadol Improve Patient-controlled Analegsia with Intravenous Injection of Sufentanil for Post-thoracotomy Pain

作　　者：伍源[1] 邓乾[1] 张毅[1] 张咸伟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《医药导报》2010年第12期1580-1584,共5页Herald of Medicine

摘　　要：目的观察帕瑞昔布钠联合曲马多静脉注射改善开胸手术后舒芬太尼静脉自控镇痛的临床效果。方法根据随机、双盲以及对照原则,将60例开胸手术患者随机分为对照组(S组)、帕瑞昔布钠组(P组)、帕瑞昔布钠联合曲马多组(C组),各20例。P组给予帕瑞昔布钠40mg,手术前0.5h静脉注射;C组给予帕瑞昔布钠40mg,手术前0.5h静脉注射,手术结束前0.5h静脉注射曲马多2mg·kg-1。盲法评估记录3组手术后0.5,8,12,24,48h的静息和活动(深呼吸、咳嗽时)视觉模拟评分法(VAS)疼痛评分、自控镇痛(PCA)的实际按压次数和有效按压次数、苏醒期躁动、在手术后恢复室(PACU)的滞留时间、不良反应及镇痛满意度评分。结果手术后0.5,8,12,24,48hVAS疼痛评分C组和P组均低于S组(P<0.05),术毕0.5h时C组、P组的静息VAS疼痛评分分别为1.80±0.52和2.50±0.95(P<0.05),活动VAS疼痛评分分别为2.85±0.76和3.30±1.38(P<0.05);PCA有效按压次数C组和P组少于S组(P<0.05);苏醒期C组、P组、S组躁动的发生率分别为10.0%,50.0%和90.0%(P<0.05);3组患者在PACU的滞留时间及不良反应发生率差异无显著性(P>0.05);C组和P组的镇痛满意度相近(P>0.05),但均高于S组(P<0.05)。结论静脉注射帕瑞昔布钠联合曲马多可有效改善开胸手术后舒芬太尼静脉自控镇痛的临床效果。Objective To observe whether combination of parecoxib sodium with tramadol improves the effect of patient-controlled intravenous analgesia with sufentanil after thoracotomy.Methods Sixty patients（ASAⅠ-Ⅱ）were randomly divided into there groups：control group（group S,n=20）;parecoxib sodium group（group P,n=20）,in which parecoxib sodium 40 mg was intravenously administered 0.5 h before operation;combination of parecoxib sodium and tramadol group（group C,n=20）,in which parecoxib sodium was intravenously injected 0.5 h before operation and tramadol 2 mg·kg-1 was administrated 0.5 h before the end of operation.The visual analogue scale（VAS）for asssessing resting and motion pain,the actual/effective number of PCA,the level of restlessness and residence time in PACU at 0.5,8,12,24,48 h postoperatively were evaluated and recorded,the side effects and overall satisfaction to analgesic therapy were questioned at 48 h.Results The resting and motion VAS of pain were significantly lower in group C and group P compared to those in group S at each time points postoperatively（P0.05）,the resting VAS of pain in group C and group P were separately recorded as 1.80±0.52 and 2.50±0.95（P0.05）,and the motion VAS of pain were 2.85±0.76 and 3.30±1.38（P0.05）;The effective number of PCA was significantly fewer in group C and group P than that in group S;The rates of restlessness were 10.0%,50.0% and 90.0% in group C,group P and group S（P0.05）.No significant differences among three groups of the residence time at PACU and side effects were found（P0.05）.The overall satisfaction to analgesic therapy of group C and group P were similar（P0.05）,and better than group S（P0.05）.Conclusion Intravenous parecoxib sodium combining with tramadol can improve the effect of patient-controlled intravenous analgesia with sufentanil after thoracotomy.

关 键 词：帕瑞昔布 曲马多 舒芬太尼 镇痛 患者控制 手术 胸科 

分 类 号：R971.2[医药卫生—药品] R655[医药卫生—药学]