帕瑞昔布钠联合舒芬太尼患者自控镇痛用于拇手指再造术的临床效果  

Postoperative analgesic effects of Parecoxib Sodium combined with Sufentanil PCIA on patients undergoing thumb and finger reconstruction

作　　者：王德明[1] 邹青[1] 张元信[1] 曲彦亮[1] 张立新[1] 陈淑琴[1] 安丰妹[1] 

机构地区：[1]解放军第401医院全军手外科中心,山东青岛266071

出　　处：《中国现代医学杂志》2013年第3期72-75,共4页China Journal of Modern Medicine

摘　　要：目的将帕瑞昔布钠联合舒芬太尼患者静脉自控镇痛（PCIA）用于拇手指再造术,观察帕瑞昔布钠对舒芬太尼用量及镇痛效果的影响。方法 80例ASAI~Ⅱ级拟做足趾移植再造拇手指术患者,随机双盲分成两组,帕瑞昔布钠组（P组,n=40）和对照组（C组,n=40）。两组术中均先用0.5%盐酸罗哌卡因40 mL进行腋路臂丛神经阻滞,观察20 min后,选择L3-4间隙穿刺进行腰麻-硬膜外联合麻醉,腰麻用0.5%盐酸布比卡因重比重液2.5~3.0 mL并置入硬膜外导管备用。P组在手术开始、开始后每12 h分别静注帕瑞昔布钠40 mg,C组给予等量生理盐水。术后2组接静脉自控镇痛泵。术中监测患者的血压（BP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SPO2）;观察术后镇痛效果及6、24、48 h舒芬太尼的用量、PCA按压总次数和有效次数,术后VAS评分,记录不良反应及对镇痛效果的满意度。结果 P组与C组相比,术后48 h舒芬太尼的用量显著减少（P〈0.05）,术后48 h时PCA按压总次数和有效次数显著降低（P〈0.05）;术后4、6、12、24、48 h VAS评分显著降低（P〈0.05）。两组Ramsay镇静评分、不良反应发生率差异无显著性（P〉0.05）。结论帕瑞昔布钠联合舒芬太尼PCIA用于拇手指再造术的镇痛效果优于单纯舒芬太尼自控镇痛,同时减少了术后镇痛泵中舒芬太尼的用量,提高患者术后镇痛质量。[Objective] To investigate the postoperative analgesic effects of parecoxib sodium combined with sufentanil PCIA on patients after thumb and finger reconstruction. [ Methods ] Eighty patients undergoing thumb and finger reconstruction were selected and randomly dvided into two groups （n =40）： the parecoxib sodium group （Group P） and the control group （Group C）. Two groups first received brachial plexus block. Then in all patients epidural L3-4 were selected and received spinal-epidural combined anesthesia （CSEA）. After the success of bracbial plexus block and CSEA, patients in Group P were administered one bolus of parecoxib sodium （40 rag, diluted by 2 mL N.S.） intravenously and patients in group C received intravenous NS 2 mL instead of parecoxib 30 min before the end of operation. The patients in both groups received PCIA immediately after surgery. The vital signs such as SPO2, blood pressure and pulse rate were observed during PCIA. Pain intensity was messured by visual analog scale （VAS） score at 2, 4, 8, 12, 24 and 48 h after operation. The total consumption of sufentanil, the total number and the valid num- ber of pressing PCA pump were recorded at 48 h after operation. Meanwhile, the score of Ramsay sedation scale and the adverse effects such as nausea and vomiting, pruritus and respiratory depression were observed after operation.[ Results ] Compared with group C, there were significant decreases in the score of VAS, sufentanil consumption, the total number and the valid number of pressing PCA pump in group P （P 〈0.05） at time points after operation. There were no differences in the score of Ramsay sedation scale and the incidence of adverse effects between two groups. [ Conclusion] Parecoxib sodum combined with sufentanil PCIA is safe and effective on postoperative analgesic ef- fects after thumb and finger reconstruction. Parcoxib sodium could be a good choice of perioperative multimodal analgesia techniques.

关 键 词：环氧化酶 帕瑞昔布钠 舒芬太尼 静脉自控镇痛 拇手指再造 

分 类 号：R614.4[医药卫生—麻醉学]