帕瑞昔布不同途径注射对腹腔镜胆囊切除术后早期镇痛效果的比较  

The Analgesia Effect with Different Injection Pathways of Parecoxib for Patients after Laparoscopic Cholecystectomy

作　　者：李荣[1] 陈彪[1] 蔡强[1] 王静[1] 吴娟[1] 

机构地区：[1]包头医学院第一附属医院麻醉科,内蒙古包头014010

出　　处：《内蒙古医学杂志》2010年第10期1192-1194,共3页Inner Mongolia Medical Journal

摘　　要：目的：观察对比帕瑞昔布单次静脉注射或者肌肉注射不同途径给药对腹腔镜胆囊切除术后镇痛的效果。方法：择期腹腔镜胆囊手术患者60例,ASAⅠ~Ⅱ级。随机分为3组,每组20例。V组帕瑞昔布单次静脉注射组;M组帕瑞昔布单次肌肉注射组;C组无术后镇痛组。3组均常规静脉麻醉诱导,瑞芬太尼3ng/ml、丙泊酚2.5~4μg/ml TCI麻醉维持,于手术结束前20 min。V组帕瑞昔布静脉注射40 mg;M组帕瑞昔布肌肉注射40 mg;C组：无术后镇痛组。术后使用视觉评分法观察并记录24 h内3组患者术后切口疼痛及肩背部疼痛或不适出现时间、疼痛强度（VAS值）（VAS值达到4.0为有明显疼痛）。V、M组分别与C组对比术后出现切口疼痛及肩背部疼痛VAS值达到4.0的时间;M组与V组对比术后出现切口疼痛及肩背部疼痛VAS值达到4.0的时间。观察并记录术后24 h内患者出现的胃肠道并发症。结果：V、M组各自术后出现切口疼痛VAS值达到4.0的时间（h）明显长于C组（P〈0.01）。M组术后切口疼痛VAS达到4.0的时间明显长于V组（P〈0.01）。而对于因CO2气腹刺激引起的肩背部疼痛,3组对比均无显著性差异（P〉0.05）。术后24 h内,V组有4例、M组有1例、C组有1例患者出现恶心、呕吐症状。结论：帕瑞昔布静脉注射或肌肉注射,均可在术后早期抑制患者切口疼痛,均不能有效抑制CO2人工气腹刺激引起的肩背部疼痛或不适。静脉注射后患者术后易发生恶心、呕吐。Objective：To investigate the analgesia effect with parecoxib of IV or IM after laparoscopic cholecystectomy.Methods： Sixty ASAⅠ～Ⅱ patients of selective laparoscopic cholecystectomy were randomly divided into 3 group（n=20 each） ： intravenous injection with parecoxib group（V group）,muscular injection group （M group） and contract group（C group）.Anesthesia methods ：The three groups were respectively induced with routine intravenous general anesthetics and maintained with remifentanil and propofol TCI.In group V,parecoxib were introvenous injected 20 minutes before the end of anesthesia.In group M,parecoxib were muscular injected 20 minutes before the end of anesthesia.In group C,no parecoxib were injected 20 minutes before the end of anesthesia.The occurrence time and intension of pain after the end of anesthesia were recorded with VAS and the Gastrointestinal complication 24 hours after the end of anesthesia were recorded.Results： The occurrence time of VAS value 4.0 of pain of operation incisions in group V and in group M were significantly longer than that in group C（P〈0.01）.The occurrence time of VAS value 4.0 of pain of operative incisions in group M were significantly longer than that in group M（P〈0.01）.There were no significant difference of the three group of the occurrence time of VAS value 4.0 of pain of shoulder and back（P〈0.05）.Nausea and vomiting occurred in 4 patients in group V,1 patients in group M and 1 patients in group C respectively.Conclusion： Parecoxib of IV or IM can significantly relieve pain of operative incisions but can not relieve pain of shoulder and back for the CO2 artificial pneumoperitoneum after laparoscopic cholecystectomy.Nausea and vomiting occurred readily in patients with parecoxib intravenous injection.

关 键 词：腹腔镜胆囊切除术 术后镇痛 

分 类 号：R657.4[医药卫生—外科学] R614[医药卫生—临床医学]