预注帕瑞昔布钠用于胆肠吻合术患者的临床研究  

Clinical study of pre-injection of parecoxib in patients undergoing choledochojejunostomy

作　　者：李军[1] 刘英海[1] 牛洁[1] 代雪梅[1] 叶占勇[1] 刘合年[1] 

机构地区：[1]成都军区总医院麻醉科,成都610083

出　　处：《西南国防医药》2011年第4期371-373,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：成都军区医学科研"十一五"计划课题(MB07011);第47批中国博士后科学基金面上资助(20100471764)

摘　　要：目的观察术前预注帕瑞昔布钠对胆肠吻合术患者麻醉与术后镇痛效果的影响。方法择期行胆肠吻合术患者40例,随机双盲分为C组和P组。C组麻醉诱导前15 min给予生理盐水5 ml,P组给予帕瑞昔布钠40 mg(生理盐水5 ml稀释)。两组麻醉维持均采用丙泊酚、雷米芬太尼、顺式阿曲库铵全凭静脉全身麻醉,患者清醒拔管后,采用芬太尼自控静脉镇痛(PCIA)。记录术中雷米芬太尼的用量、术毕拔管情况及术后VAS评分、PCIA芬太尼用量和不良反应。结果术中麻醉维持P组的雷米芬太尼用量及平均泵注速度均小于C组(P<0.01),且拔管时烦躁例数也少于C组(P<0.01),P组在0、6、12 h的VAS评分低于C组(P<0.01或P<0.05),PCIA按压次数和芬太尼用量也均少于C组(P<0.01或P<0.05),两组拔管时间及不良反应的差异无统计学意义。结论胆肠吻合术术前预注帕瑞昔布钠可减少术中雷米芬太尼的用量,防止拔管时烦躁,并增强PCIA中芬太尼的镇痛效果,减少芬太尼用量。Objective To observe the effects of pre-injection of parecoxib on anesthesia and analgesic efficacy of postoperative patient controlled intravenous analgesia（PCIA）in patients undergoing choledochojejunostomy.Methods 40 patients undergoing elective choledochojejunostomy were randomly and double-blindly divided into group C and group P.Patients were intravenously injected normal saline of 5 ml in group C or sodium parecoxib of 40 mg（diluted by 5 ml of normal saline）in group P at 15 min before anesthesia.Total intravenous anesthesia was maintained with propofol,remifentanil and cisatracurium,and PCIA with fentanyl was used for postoperative analgesia after awakening and extubation.The operative consumption of remifentanil and fentanyl,the status of extubation,postoperative visual analogue scale（VAS）as well as adverse effects were recorded.Results The consumption and mean infusion velocity of remifentanil were lower in group P than those in group C（P0.01）.Restlessness patients during extubation were less in group P than those in group C（P0.01）.The VAS in group P was significantly lower than that in group C at 0,6 and 12 h after operation（P0.01 or P0.05）.The pressed number and the fentanyl consumption during PCIA were markedly lower in group P than those in group C（P0.01 or P0.05）.The time of waiting for extubation and postoperative adverse effects had no significant differences between the two groups.Conclusion The consumption of remifentanil and occurrence of postoperative restlessness during extubation may decrease by the pre-injection of parecoxib in patients undergoing choledochojejunostomy.Parecoxib can enhance the analgesic efficacy of fentanyl and spare the fentanyl consumption during PCIA.

关 键 词：帕瑞昔布钠 胆肠吻合术 雷米芬太尼 芬太尼 术后镇痛 

分 类 号：R971[医药卫生—药品]