帕瑞昔布超前镇痛在腹股沟疝修补术中的应用  

Preemptive Analgesic Effect of Parecoxib in Patients Undergoing Inguinal Hernia Repair

作　　者：宋应寒[1] 马东扬[1] 陆安清[1] 谢妍妍 郭东姣[1] 叶丽娜[1] 李克书[1] 雷文章[1] 

机构地区：[1]四川大学华西医院胃肠外科中心,成都610041

出　　处：《华西医学》2015年第5期873-876,共4页West China Medical Journal

摘　　要：目的观察帕瑞昔布超前镇痛用于腹股沟疝无张力修补术的效果。方法 2013年5月-8月将120例择期行疝修补术患者随机分为A、B两组,每组60例。A组于术前45 min静脉注射帕瑞昔布钠40 mg,B组术前45 min静脉注射等量生理盐水。两组患者均于利多卡因局部麻醉下行无张力腹股沟疝修补术。评估术后2、4、8、12 h的视觉模拟评分(VAS)和最高VAS评分;比较两组使用补救性镇痛药物曲马多的例数、不良反应、术后住院时间及对术后镇痛的满意度。术前及术后24 h检测外周血前列腺素E2(PGE2)水平。结果 A组患者术后2、4、8、12 h的VAS评分及术后最高VAS评分均低于B组,差异有统计学意义(P<0.05),术后24 h VAS评分两组差异无统计学意义(P>0.05);术后A组和B组分别有3例和11例患者使用曲马多,差异有统计学意义(χ2=5.175,P=0.023);A组和B组分别有2例和8例患者发生不良反应,差异有统计学意义(χ2=3.927,P=0.048)。A组术后住院时间短于B组,对镇痛的满意度高于B组,差异均有统计学意义(P<0.05)。两组患者术前、术后PGE2水平差异无统计学意义(P>0.05)。结论帕瑞昔布超前镇痛用于腹股沟疝无张力修补术镇痛效果确切,不良反应少,患者满意度高,有利于患者早日康复。Objective To evaluate the preemptive analgesic efficiency of parecoxib on patients undergoing inguinal hernia repair. Methods One hundred and twenty patients scheduled for surgery between May and August 2013 were randomized into group A（n=60） and group B（n=60）. Patients in group A received intravenous parecoxib sodium（40 mg） for 45 minutes before surgery while group B received equivalent normal saline. All patients underwent tensionfree hernia repair under local anesthesia with simplex lidocaine. Visual analogy scores（VAS） after surgery and the maximum VAS were recorded. The number of patients requiring rescue analgesic（tramadol injection） or with adverse ef ects related to analgesia were observed and recorded. Postoperative hospital stay and patient satisfaction score with analgesic ef ect were compared between the two groups. Concentrations of plasma prostaglandin E2（PGE2） before surgery and 24 hours at er surgery were measured in both groups. Results VAS scores were signii cantly lower in group A at 2, 4, 8 and 12 hours at er surgery than group B, while no signii cant dif erence was seen at er 24 hours of the surgery. The number of patients requiring tramadol（3/60） or with adverse ef ects（2/60） in group A were signii cantly lower than that in group B（11/60 and 8/60 respectively）. Postoperative hospital stay was shorter while patient satisfaction score with analgesic ef ect was higher in group A than in group B. There were no signii cant dif erences in concentration of plasma PGE2 between the two groups before surgery and at er 24 hours of the surgery（P〉0.05）. Conclusion Preemptive administration of parecoxib for hernia repair can result in signii cant analgesic ef ect with fewer adverse ef ects, higher patient satisfaction and faster recovery.

关 键 词：超前镇痛 帕瑞昔布 疝修补术 前列腺素E2 

分 类 号：R614[医药卫生—麻醉学]