帕瑞昔布钠在腹腔镜胆囊切除术中超前应用的随机对照研究  

A randomized controlled study on the application of parecoxib sodium in laparoscopic cholecystectomy

作　　者：石小莉[1] 黎平[2] 何琴[1] 贺强[1] 

机构地区：[1]重庆医科大学附属第一医院肝胆外科,400016 [2]重庆医科大学附属第一医院麻醉科,400016

出　　处：《重庆医学》2016年第36期5075-5077,共3页Chongqing medicine

基　　金：重庆医科大学附属第一医院科研基金资助项目(HLJJ2012-18)

摘　　要：目的探讨帕瑞昔布钠对腹腔镜胆囊切除术的超前镇痛作用及对患者致炎因子的影响观察。方法将择期拟行全身麻醉下腹腔镜胆囊切除术患者96例分为A组、B组、C组,每组32例。A组于全身麻醉诱导时静脉注射帕瑞昔布钠40mg(稀释成5mL),术毕前15min静脉注射5mL生理盐水;B组全身麻醉诱导时、术毕前15min分别予以5mL生理盐水、帕瑞昔布钠40mg(稀释为5mL)静脉注射;C组于全身麻醉诱导时及术毕前15min均予以5mL生理盐水静脉注射。比较3组患者术后12h患者自控镇痛(PCA)按压总数和有效按压次数、视觉模拟评分法(VAS)评分,术前、术毕即刻、术后2h、术后12h、术后24h血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-12的水平。结果 A组术后12hPCA总按压次数和PCA有效按压次数明显低于B、C组(P<0.05);A组术后1、2、4、6、8、12h的VAS评分较B、C组低(P<0.05),而术后24hA组与B组未见明显差异(P>0.05)。3组患者术毕即刻、术后2h、术后12h、术后24h的IL-6、TNF-α水平变化为:A组<B组<C组,IL-12各时点比较:A组>B组>C组。结论腹腔镜胆囊切除术中超前应用帕瑞昔布钠具有良好的镇痛效果,全身麻醉诱导时应用比术毕前应用效果更佳,且其发挥镇痛作用同时可降低炎症因子IL-6、TNF-α的产生,提高IL-12的水平,有利于术后恢复。Objective To observe the effect of parecoxib sodium on relieving acute postoperative pain and inflammatory fac‐tors in laparoscopic cholecystectomy .Methods Totally 96 cases of laparoscopic cholecystectomy were randomly divided into 3 groups ：experimental group （group A ,group B） and control group（group C） ,32 cases in each group .Group A received intravenous infusion of parecoxib sodium 40 mg （diluted to 5 mL ） intravenously at the induction of general anesthesia and intravenous injection of 5 mL normal saline 15 min before surgery .In group B ,anesthesia induction ,15 minutes before surgery were given 5 mL of normal saline ,parecoxib sodium 40 mg （diluted to 5 mL） intravenously .In group C ,5 mL of normal saline was given intravenously at the time of general anesthesia induction and 15 min before operation .The total number of PCA and the number of effective compres‐sions and VAS scores at 12 h postoperatively ,the levels of serum TNF‐α,IL‐6 and IL‐12 before operation ,immediately after opera‐tion ,at 2 ,12 ,24 h after operationwere compared .Results The PCA press times and effective press times of patients in group A within 12 hours after the operation were much less than those in group B ,C（all P〈0 .05） .The VAS scores of group A at 1 ,2 ,4 ,6 , 8 and 12 h were lower than those in group B and C （P〈0 .05） ,but there was no significant difference between group A and group B after 24 h（P〉0 .05） .The changes of serum IL‐6 ,TNF‐αlevel in three groups of patients at the end of the operation ,2 ,12 ,24 h after operationwere ：group A group B 〉 group C . Conclusion Parecoxib sodium has a good analgesic effect of laparoscopic cholecystectomy in the induction of general anesthesia than before the end of the operation and application effect is better ,and its analgesic effect can reduce the production of inflammato‐ry factors IL‐6 and TNF‐α,and increase the level of IL‐12 ,which is beneficial to postoperative recovery .

关 键 词：帕瑞昔布钠 胆囊切除术 腹腔镜 超前镇痛 炎症因子 

分 类 号：R657.4[医药卫生—外科学]