预注帕瑞昔布钠对妇科手术后镇痛的影响与预先镇痛效应的观察  

Effect of perioperative intravenous parecoxib sodium on postoperative and preemptive analgesia in gynecological surgery

作　　者：李荣胜[1] 廖永强[1] 蓝晓文[1] 谢华杰[1] 韩琪[1] 蔡友娟[1] 

机构地区：[1]广东省东莞市人民医院麻醉科,523059

出　　处：《实用疼痛学杂志》2015年第2期112-115,共4页Pain Clinic Journal

基　　金：东莞市医疗卫生科技计划项目（201210515000098）

摘　　要：目的探讨围术期不同时点静脉注射帕瑞昔布钠对妇科手术后患者术后镇痛的影响，并评估帕瑞昔布钠的预先镇痛效应。方法择期行妇科手术患者75例，随机分成3组（TI=25），Ⅰ组未用帕瑞昔布钠，Ⅱ组切皮前10min静脉注射帕瑞昔布钠40mg，Ⅲ组术毕静脉注射帕瑞昔布钠40mg；术后PCA镇痛48h，观察术后6、12、24、36、48h疼痛视觉模拟评分（VAS）、Ramsay镇静评分（RSS），记录布托啡诺用量、患者满意度及不良反应。结果Ⅱ组和Ⅲ组患者术后12、24h时VAS评分及48h布托啡诺用量均显著低于Ⅰ组（P〈0．05），患者对镇痛的满意度优效者Ⅱ组为14例（56％）、Ⅲ组15例（60％）高于Ⅰ组7例（28％），Ⅱ组和Ⅲ组间VAS、RSS评分及术后布托啡诺用量均无统计学差异（P〉0．05）；3组患者不良反应发生率亦无统计学差异（P〉0．05）。结论妇科手术围术期静脉注射帕瑞昔布可降低术后镇痛药布托啡诺PCA用量，增强其镇痛效果，但术前或术毕应用相比并未显示预先镇痛效应。Objective To investigate the effect of pre- or postoperative injection of parecoxib sodium on postoperative analgesia after gynecological surgery, and evaluate the preemptive analgesic effect of parecoxib. Methods Seventy-five patients scheduled for selective gynecological surgery with epidural-spinaⅠ anesthesia were divided randomly into 3 groups （n=25）. Patients in group Ⅰ received 5 ml normal saline preoperatively; group Ⅱ received parecoxib 40 mg preoperatively and group Ⅲ received parecoxib 40 mg when suturing. Patient controlled intravenous analgesia was used postoperatively with butorphanol. Pain was assessed with visual analogue scale （VAS）, Ramsay sedation score （RSS） and dosage of butorphanol, patient＇s satisfaction degree, adverse effects were also recorded. Results Patients in group Ⅱ and group Ⅲ, VAS at 12 and 24 h, and dosage of butorphanol in postoperative 48 h were significantly lower than those in group Ⅰ （P 〈 0.05）. Excellent rate of patient＇ s satisfaction degree was 56% （ 14 cases） in group Ⅱ, 60% （ 15 cases） in group Ⅲ, which was higher than that （28%, 7 cases） in group Ⅰ （P 〈 0.05）. There were no significant differences in VAS, RSS and dosage of butorphanol in postoperative between group Ⅱ and group Ⅲ. Two cases of somnolence were observed in group Ⅰ. Conclusion Perioperative parecoxib sodium 40 mg can improve postoperative analgesic effect and reduce the postoperative butorphanol consumption. But compared with postoperative dose, preoperative parecoxib does not show significant preemptive analgesia in the study.

关 键 词：帕瑞昔布钠 布托啡诺 预先镇痛 妇科外科手术 疼痛 手术后 镇痛 患者控制 

分 类 号：R614.42[医药卫生—麻醉学]