帕瑞昔布钠联合超声引导椎旁神经阻滞用于胸科手术多模式镇痛的临床研究  

Effect of multimodal analgesia of parecoxib sodium combined with ultrasound-guided thoracic paravertebral block on early postoperative analgesia in patients with thoracic surgery

作　　者：王莉娟[1] 马民玉[1] 孙振涛[1] 孙雪青[1] 杨晶晶[1] 杨文静[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,450052

出　　处：《中华实验外科杂志》2016年第9期2223-2226,共4页Chinese Journal of Experimental Surgery

摘　　要：目的 观察帕瑞昔布钠联合超声引导胸椎旁神经阻滞的多模式镇痛方式对胸科手术患者术后早期镇痛效应的影响.方法 行择期食管癌根治术患者120例,随机分为4组：N组患者术后镇痛仅使用舒芬太尼0.2 μg/kg;P组使用舒芬太尼0.2μg/kg＋帕瑞昔布钠40 mg;T组患者使用舒芬太尼0.2 μg/kg＋超声引导下胸椎旁神经阻滞;PT组患者使用舒芬太尼0.2 μg/kg＋帕瑞昔布钠40 mg＋超声引导下胸椎旁神经阻滞.记录患者苏醒即刻躁动评分（RSS）和苏醒即刻（T1）、出恢复室即刻（T2）、术后3 h（T3）、6 h（T4）、12 h（T5）和24 h（T6）安静与咳嗽时的视觉模拟评分法（VAS）和Prince-Henry评分;以及术后镇痛泵总使用时间、24 h的镇痛满意度和不良反应发生率.结果 （1）N、P、T、PT组患者苏醒期RSS评分分别为（2.20±0.63）、（1.40±0.52）、（1.10±0.74）和（0.50±0.71）分.与N组比较,P、T、PT组苏醒即刻RSS评分均降低（P＜0.05）;与PT组比较,P、T组苏醒即刻RSS评分均增高（P＜0.05）.（2）N组术后T1、T2、T3、T4、T5、T6的VAS评分分别为（5.29±0.63）、（5.12±0.74）、（5.24±0.63）、（5.07±0.82）、（4.73±0.67）、（4.45±0.70）分;Prince-Henry评分分别为（3.21 ±0.42）、（2.83±0.41）、（2.25±0.39）、（2.17 ±0.31）、（2.24±o.41）、（2.35±0.35）分.P组术后T1、T2、T3、T4、T5、T6的VAS评分分别（1.72±0.67）、（2.03±0.67）、（2.14 ±0.74）、（2.47±0.52）、（4.11±0.74）、（4.25±0.76）分;Prince-Henry评分分别为（0.84±0.32）、（0.92±0.27）、（1.31 ±0.24）、（1.52 ±0.21）、（2.07±0.31）、（2.07±0.31）分.T组术后T1、T2、T3、T4、T5、T6的VAS评分分别为（1.53±o.71）、（1.72±0.67）、（1.91±0.57）、（1.97±0.57）、（2.24 ±0.63）、（3.71±0.82）分;Prince-Henry评分分别为（0.73±0.34）、（0.74±0.24）、（1.14±0.37）、（1.27±0.28）、（1.42±0.32）、（2.13±0.Objective To explore the effect of the multimodal analgesia of parecoxib sodium combined with ultrasound-guided thoracic paravertebral block on early postoperative analgesia in patients with thoracic surgery.Methods A total of 120 patients who underwent scheduled esophageal cancer radical surgery were randomly divided into four groups：group N,group P,group T and group PT.For postoperative analgesia,sufentanil （0.2 μg/kg） was given in group N,sufentanil （0.2 μg/kg） plus parecoxib sodium （40 mg）were given in group P,safentanil （0.2 μg/kg） plus ultrasound-guided thoracic paravertebral block were giverin group T,and sufentanil （0.2 μ g/kg） plus parecoxib sodium （40 mg） plus ultrasound guided thoracic paravertebral block were given in group PT.Ramesay Sedation-Agitation scores （RSS） at the time of patients woke up （T1）,visual analogue scale（VAS） and Prince-Henry scores both at rest and with coughing at the time of patients woke up （T1）,the time of patients out of the post anesthesia care unit （PACU,.T2） and the time of 3 h （T3）,6 h （T4）,12 h （T5） and 24 h （T6） after the surgery were rec6rded.The total time of analgesia pump used,analgesia satisfaction and the rate of adverse reactions during 24 h after surgery were recorded as well.Results （1） The RSS scores of patients in groups N,P,T,and PT were （2.20 ± 0.63）,（1.40 ± 0.52）,（1.10 ± 0.74） and （0.50 ± 0.71） respectively.As compared with group N,RSS scores were decreased at T1 in groups P,T and PT （P 〈 0.05）.As compared with group PT,RSS scores were increase at T1 in groups P and T （P 〈 0.05）.（2） The VAS scores of patients in group N at T1,T2,T3,T4,T5 and T6 were 5.29 ±0.63,5.12 ±0.74,5.24 ±0.63,5.07 ± 0.82,4.73 ± 0.67,and 4.45 ± 0.70 respectively and the Prince-Henry scores were 3.21 ± 0.42,2.83 ±0.41,2.25-±0.39,2.17 ±0.31,2.24 ±0.41,and 2.35 ±0.35 respectively.The VAS scores of patients in group P at T1,T2,T3,T4,T5 and T6 were 1.72 ±0.67,2.03 ±0.67,2

关 键 词：胸科手术 超声引导 胸椎旁神经阻滞 帕瑞昔布钠 多模式镇痛 

分 类 号：R655[医药卫生—外科学]