帕瑞昔布联合腹腔内罗哌卡因用于腹腔镜胆囊切除术后镇痛  

The abirritation of parecoxib combined with intraperitoneal ropivacaine in laparoscopic cholecystectomy

作　　者：刘付丽[1] 唐红丽[1] 董晓西[1] 施克俭[1] 郑浩[1] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,浙江温州325000

出　　处：《肝胆胰外科杂志》2011年第1期21-23,共3页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的观察帕瑞昔布联合腹腔内重复滴注罗哌卡因应用于腹腔镜下胆囊切除术(LC)的术后镇痛效果。方法选择行LC的患者60例,随机分为帕瑞昔布复合罗哌卡因(PR复合)组和对照组。PR复合组患者于气腹建立后和术后6 h,向胆囊表面、膈下喷洒0.75%罗哌卡因10 mL,在手术缝合腹壁切口前,向每个切口局部注入相同局麻药液2 mL。对照组术中和术后6 h向胆囊表面、膈下喷洒生理盐水10 mL,每个切口注射生理盐水2 mL,两组患者在缝合切口前静脉注射帕瑞昔布40 mg。记录术后1 h,3 h,6 h,12 h,24 h VAS评分、镇痛药用量及副反应发生情况。结果 PR复合组于术后1 h,3 h,6 h,12 h,24 h的VAS评分显著小于对照组(P<0.01)。24 h的静脉吗啡需求量PR复合组为(1.4±2.3)mg,对照组为(7.2±4.8)mg,PR复合组吗啡用量显著少于对照组(P<0.01),两组患者均未见局麻药中毒反应发生。结论 LC腹腔内重复滴注罗哌卡因联合帕瑞昔布术后镇痛效果良好,减少术后镇痛药需求。Objective To observe the abirritation of parecoxib combined with intraperitoneal administration of ropivacaine on pain after laparoscopic cholecystectomy.Methods Sixty patients undergone laparoscopic gallbladder surgery were randomly divided into PR（parecoxib combined with intraperitoneal ropivacaine） group and the control group.After pneumoperitoneum was achieved,10 mL of 0.75% ropivacaine were administered intraperitoneally in the PR group and repeated 6 h postoperatively,Ropivacaine 2 mL was infiltrated on each abdominal incision before suture.Whereas in the controls,0.9% NaCl were administered in the corresponding time points.Parecoxib（40 mg/5 mL） was administered intravenously to all patients before suture.Scores of visual anologue scale（VAS）,dose of analgesia and the incidence of adverse effects were recorded at the 1 h,3 h,6 h,1 2 h and 24 h after the operation.Results The VAS score in the PR group in the patients recorded at each time point was significantly lower than that in the control group（P0.01）.In the PR group the consumption of morphine was（1.4±2.3）mg,while in the control group was（7.2±4.8）mg,and the dose of analgesic also decreased in the PR group（P0.01）,the adverse effects of local anesthetics in two groups had no statistical defference.Conclusion Repeated intraperitoneal administration of ropivacaine combined with precoxib demonstrates better postoperative relief of pain after laparoscopic cholecystectomy,and reduced the consumption of postoperative analgesic requirement.

关 键 词：胆囊切除术 腹腔镜 术后镇痛 帕瑞昔布 腹腔 罗哌卡因 

分 类 号：R614.3[医药卫生—麻醉学]