帕瑞昔布钠不同给药方式对乳腺癌改良根治术患者术后吗啡用量的影响  

Effect of parecoxib sodium of different delivery ways on modified radical mastectomy of breast cancer patients postoperative morphine consumption

作　　者：高嵩[1] 田文华[1] 李建军[1] 周卫民[1] 

机构地区：[1]武汉市汉口医院麻醉科,湖北武汉430012

出　　处：《现代医学》2012年第4期420-423,共4页Modern Medical Journal

摘　　要：目的:观察帕瑞昔布钠不同给药方式对乳腺癌改良根治术患者术后吗啡镇痛的影响。方法:择期行乳腺癌改良根治术患者60例,年龄45～69岁,ASAⅠ～Ⅱ级,随机分为2组(n=30):帕瑞昔布钠超前镇痛组(A组)和帕瑞昔布钠常规镇痛组(B组)。静脉注射咪达唑仑、丙泊酚、舒芬太尼、维库溴铵麻醉诱导,吸入七氟烷,间断给予舒芬太尼或维库溴铵维持麻醉。A组切皮前15 min静脉注射首剂帕瑞昔布钠40 mg,手术结束前30 min静脉注射0.9%氯化钠注射液2 ml,间隔12 h后静脉注射帕瑞昔布钠40 mg;B组切皮前15 min静脉注射0.9%氯化钠注射液2 ml,手术结束前30 min静脉注射首剂帕瑞昔布钠40 mg,间隔12 h后静脉注射帕瑞昔布钠40 mg。术毕两组患者均采用吗啡患者自控镇痛,记录术后2、4、8、12、24 h的视觉模拟评分(VAS),24 h按压总次数和有效按压次数,术后24 h吗啡用量和不良反应发生情况。结果:与B组比较,A组术后各时点VAS评分差异均无统计学意义,24 h总按压次数和有效按压次数均明显减少,术后24 h吗啡用量减少(P<0.05),两组患者术后不良反应发生无明显差异(P>0.05)。结论:帕瑞昔布钠联合吗啡多模式超前镇痛对乳腺癌改良根治术患者术后镇痛,可减少吗啡用量,有利于患者恢复。Objective： To observe the effects of parecoxib sodium of different delivery ways on modified radical mastectomy of breast cancer patients postoperative morphine analgesia effect.Methods： Undergoing modified radical mastectomy of breast cancer patients with 60 cases,aged 45 to 69 years old,ASA Ⅰ-Ⅱ,were randomly divided into 2 groups（n=30）：preemptive analgesia effects of parecoxib group（group A） and parecoxib conventional analgesia group（group B）.Intravenous midazolam,propofol,sufentanil,vecuronium bromide inhalation induction of anesthesia,seven halothane,interrupted administration of sufentanil or vecuronium maintenance of anesthesia.Group A 15 min before skin incision intravenous injection of first dose of parecoxib sodium 40 mg and 30 min before the end of the operation intravenous injection of 0.9% sodium chloride injection of 2 ml and after 12 h interval intravenous parecoxib sodium 40 mg,group B 15 min before skin incision intravenous injection of 0.9% sodium chloride injection of 2ml and 30 min before the end of the operation the first agent of parecoxib sodium 40 mg and after 12 h interval intravenous parecoxib sodium 40 mg.After operation patients in two groups were with morphine patient-controlled analgesia.Recorded after 2,4,8,12,24 h visual analogue scale（VAS）,the total number of 24 h press and press times,after 24 h morphine consumption and the occurrence of adverse reactions.Results： Compared with group B,group A on each time VAS scores showed no significant differences,24 h press times and effective pressing were significantly decreased.After 24 h,morphine dosage was decreased（P0.05）,the adverse reactions of patients in two groups showed no significant differences（P0.05）.Conclusion： Parecoxib combined with morphine of preemptive analgesia on modified radical mastectomy of breast cancer patients with postoperative analgesia,can reduce the morphine dosage,is conducive to the recovery of patients.

关 键 词：帕瑞昔布钠 乳腺癌改良根治术 吗啡 超前镇痛 自控镇痛 

分 类 号：R737.9[医药卫生—肿瘤] R655.8[医药卫生—临床医学]