帕瑞昔布钠联合罗哌卡因切口浸润对腹式肝脏部分切除术患者麻醉恢复期躁动的影响  

Effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy

作　　者：杨楠木[1] 周一[2] 李庆军[1] 韩风[1] 周进学[1] 杨宝峰 张珉[1] Yang Nanmu;Zhou Yi;Li Qingiun;Hart Feng;Zhou Jinxue;Yang Baofeng;Zhang Min(Department of Hepatopancreatobiliary Surgery,Henan Cancer Hospital,Zhengzhou 450008,China;Department of Anesthesiology,Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省肿瘤医院肝胆胰外科,郑州市450008 [2]河南省肿瘤医院麻醉科,郑州市450008

出　　处：《中华麻醉学杂志》2018年第8期953-955,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价帕瑞昔布钠联合罗哌卡因切口浸润对腹式肝脏部分切除术患者麻醉恢复期躁动的影响.方法 择期行开腹肝脏切除术患者40例,年龄35~64岁,BMI 18~24 kg∕m^2,ASA分级Ⅰ或Ⅱ级,性别不限.采用随机数字表法分为2组(n=20):帕瑞昔布钠组(P组)和帕瑞昔布钠+罗哌卡因组(RP组).P组于术前30 min时静脉注射帕瑞昔布钠40 mg;RP组术前30 min时静脉注射帕瑞昔布钠40 mg,术毕时以0.5%罗哌卡因20 ml行切口浸润,术毕均行PCIA.记录术毕30 min内患者躁动、呼吸抑制和恶心呕吐的发生情况.于诱导前即刻(T0)、术毕(T1)和拔除气管导管时(T2)采集桡动脉血,采用放射免疫法测定血浆皮质醇(Cor)浓度,ELISA法测定血浆肾上腺素(E)和去甲肾上腺素(NE)浓度,采用血气分析仪测定血糖(Glu).结果 与T0时比较,2组T1,2时血浆Cor、Glu、E和NE浓度升高(P>0.05).与P组比较,PR组躁动发生率和T1,2时血浆Cor、Glu、E和NE浓度降低(P<0.05).2组患者均未出现恶心呕吐和呼吸抑制.结论 帕瑞昔布钠联合罗哌卡因切口浸润可降低腹式肝脏部分切除术患者恢复期躁动的发生,与抑制应激反应有关.Objective To evaluate the effect of parecoxib combined with ropivacaine for incision infiltration on agitation during recovery from anesthesia in patients undergoing abdominal hepatectomy. Methods Forty patients of both sexes, aged 35-64 yr, with body mass index of 18-24 kg∕m^2 , of Ameri-can Society of Anesthesiologists physical statusⅠ or Ⅱ, undergoing elective partial hepatectomy, were di-vided into parecoxib sodium group ( group P ) and parecoxib sodium plus ropivacaine group ( group RP ) with 20 cases in each group. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation in group P. Parecoxib sodium 40 mg was intravenously injected at 30 min before operation, and incision in-filtration was performed with 0. 5% ropivacaine 20 ml at the end of surgery in group RP. Patient-controlled intravenous analgesia was performed at the end of surgery in both groups. The development of agitation, re-spiratory depression and nausea and vomiting was recorded within 30 min after operation. Blood samples were collected from the radial artery immediately before induction ( T0 ) , at the end of surgery ( T1 ) and at removal of extubation ( T2 ) for determination of plasma cortisone ( Cor) concentrations ( by radio-immunity method), plasma epinephrine (E) and norepinephrine (NE) concentrations (by enzyme-linked immu-nosorbent assay) and blood glucose ( using a blood gas analyzer) . Results Compared with the baseline at T0 , the plasma concentrations of Cor, Glu, E and NE were significantly increased at T1,2 in two groups ( P>0. 05) . The incidence of agitation and plasma concentrations of Cor, Glu, E and NE were significantly low-er at T1,2 in group RP than in group P ( P<0. 05) . No patients developed nausea and vomiting and respira-tory depression in two groups. Conclusion Parecoxib combined with ropivacaine for incision infiltration can decrease the occurrence of agitation during recovery from anesthesia, which is related to inhibiting stress responses of patients undergoing abdominal hepatectomy.

关 键 词：环氧化酶2抑制剂 酰胺类 麻醉恢复期 烦躁 

分 类 号：R614[医药卫生—麻醉学]