帕瑞昔布钠预防瑞芬太尼复合麻醉术后早期疼痛的临床应用  

Application of Parecoxib Sodium to Prevent Early Postoperative Pain in Remifentanil-based Combined Anesthesia

作　　者：王赫[1] 王玲玲[1] 马虹[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2011年第11期1040-1043,共4页Journal of China Medical University

基　　金：辽宁省教育厅高校科研计划(2008796)

摘　　要：目的探讨静注帕瑞昔布钠对瑞芬太尼复合麻醉术后早期疼痛和阿片类药物不良反应发生率的影响．．方法选择年龄18～60岁、ASAⅠ～Ⅱ级、拟在全身麻醉下行胃大部切除手术的患者100例。随机分为静眯麻醉实验组（VA组）、静脉麻醉对照组（VB组）、吸入麻醉实验组（IA组）和吸入麻醉对照组（IB组）4组。所有患者麻醉诱导均给予长托宁0．5mg、咪达唑仑0．05mg·kg^-1、丙泊酚2mg·kg^-1、罗库溴铵0．6mg·kg^-1及瑞芬太尼2mg·kg^-1靶控，术后均使用静脉患者自控止疼泵（PCA）。术中以丙泊酚4～8mg-kg^-1·min^-1或七氟醚1—3MAC维持麻醉。手术开始及结束前实验组分别给予帕瑞昔布钠40mg静注。术毕送麻醉后恢复室记录患者苏醒拔管时间、术后1h、2h、4h、6h、12h及24h切口疼痛VAS评分、PCA使用量及相关不良反应。结果IA组与IB组患者术后24h各观察点VAS评分均高于vA组与VB组，且术后1h、2h、4h、6h时差异有统计学意义（P〈0．05），12h仅IB组差异有统计学意义（P〈0．05）；IA组与IB组患者术后24h各观察点阿片类药物累积用量均高于vA组与VB组，仅24h时，IB组药物用量差异有统计学意义（P〈0．05）。vA组与VB组术后24h内各观察点的VAS评分和阿片类累积用量差异无统计学意义。4组患者清醒拔管时间和术后不良反应的发生率差异无统计学意义。结论手术结束前静注帕瑞昔布钠40mg可降低瑞芬太尼复合麻醉手术后早期手术切口痛觉过敏，且全凭静脉麻醉较吸入麻醉能够更好的预防瑞芬太尼诱发的痛觉过敏，Objective To investigate the analgesic effect of parecoxib sodium used in remifentanil-based anesthesia with pmpofol or sevoflurane. Methods A total of 100 patients with ASA Ⅰ - Ⅱ scheduled for elective subtotal gastrectomy were randomized divided into 2 groups：group I and group V according to the different anesthetic maintenance regimes, and then re-divided into a treatment subgroup （A group） and a control group （B group） to receive parecoxib sodium 40 nag iv and 0.9% NS iv respectively before the end of the operation. Anesthesia for 4 groups were induced with penehychdine hydrochlofide 0.5 rag, midazolam 0.2 mg·kg^-1, pmpofol 2mg·kg^-1, remifentanil with the target concentration of 2 ng·mL^-1 and rocuronium 0.6 mg＇kg-1 intravenously to facilitate trachea intubation. All patients were received patients self-con/rolled analgesic pump for postoperative analgesia. Anesthesia was maintained with pmpofol 4-8 mg·kg^-1· h^-1 and sevoflurane 1- 3MAC, respectively, cisatracurium 0.03 mg·kg^-1 was used if neeessary to keep muscle relaxation. The patients were transferred to postopera- tive anesthetic recovery morn and recorded the time to extubation. Pain rates was evaluated by VAS（visual analogue scale/score ）and was as- sessed at 1 h,2 h,4 h,6 h, 12 h and 24 h,the cumulative volume of opioid was injected by patients-controlled analgesia pump,the opioid- related adverse effects were also recorded. Results The pain rates was cassessed by VAS and cumulative opioid consumption in inhaled anesthesia group were obviously higher than that of intravenous anesthesia group within the first 24 hours, especially in observed time of 1 h, 2 h, 4 h and 6 h （ P 〈 0.05 ）, only patients in 113 subgroup were rated higher VAS scores in 12 h time point. The cumulative opioid consumption was significantly different between inhaled anesthesia group and intravenous anesthesia group in all observed time points except the time point of 24 h when there were only patients in IB subgroup needed more opioids. There we

关 键 词：帕瑞昔布钠 瑞芬太尼 全凭静脉麻醉 吸入麻醉 

分 类 号：R971.1[医药卫生—药品]