PCEA单独或联合帕瑞昔布用于腹腔镜肝左外叶切除术后镇痛的对比研究  

PCEA in combination with parecoxib and PCEA alone for postoperative analgesia of laparoscopic left lateral hepatectomy:a control study

作　　者：彭远飞[1] 陈霏雨 王征[1] 王晓颖[1] 史颖弘[1] 周俭[1] 樊嘉[1] 

机构地区：[1]复旦大学附属中山医院肝外科,上海200032

出　　处：《中国临床医学》2017年第2期233-237,共5页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81572296;81372650);上海市自然科学基金(13ZR1406900);复旦大学附属中山医院科技创新基金~~

摘　　要：目的:探讨硬膜外患者自控镇痛(PCEA)-帕瑞昔布序贯镇痛联合改良Joel-Cohen切口用于腹腔镜肝左外叶切除术后镇痛的有效性。方法:2013年8月至2016年8月,40例肝肿瘤患者术后分为PCEA组(n=20)和PCEA-帕瑞昔布组(n=20)。所有患者均行同一方式的腹腔镜肝左外叶切除术,取标本时均采用改良Joel-Cohen切口,术后PCEA组采用硬膜外镇痛(布比卡因300mg+芬太尼500μg+0.9%氯化钠液250mL,4mL/h泵入),PCEA-帕瑞昔布组采用PCEA-帕瑞昔布序贯镇痛(24h内使用PCEA,24h后停PCEA,改用帕瑞昔布镇痛40mg静脉滴注,12h/次×2d)。以视觉模拟评分法(visual analogue scale,VAS)比较两组术后镇痛效果,同时比较两组术后排气时间、下床活动时间、导尿管拔除时间、不良反应等。结果:术后1、6、12、24、48、72h,PCEA组与PCEA-帕瑞昔布组患者静态VAS评分、动态VAS评分差异无统计学意义。PCEA-帕瑞昔布组术后排气时间短于PCEA组[(31±8.2)h vs(48±5.2)h],差异有统计学意义(P<0.001)。PCEA-帕瑞昔布组下床活动时间短于PCEA组[(18±8.2)h vs(26±5.2)h],差异有统计学意义(P<0.001)。PCEA-帕瑞昔布组尿管拔除时间短于PCEA组[(26±8.2)h vs(68±5.2)h],差异有统计学意义(P<0.001)。PCEA组术后有2例发生恶心呕吐,1例发生低血压;PCEA-帕瑞昔布组1例发生恶心呕吐,无低血压发生。结论:腹腔镜肝左外叶切除术采用改良Joel-Cohen切口时,应用PCEA-帕瑞昔布序贯镇痛可达到与传统PCEA镇痛方案等效的镇痛效果,且术后恢复更快,镇痛相关不良反应发生率更少,值得临床推广。Objective：To examine the efficacy of analgesia using sequential patient controlled epidural analgesia（PCEA）-parecoxib combined with modified Joel-Cohen incision for laparoscopic left lateral hepatectomy.Methods：From August 2013 to August 2016,40 hepatocellular carcinoma（HCC）patients were enrolled and divided into PCEA group（n=20）and PCEA-parecoxib group（n=20）.Patients in PCEA group received postoperative analgesia by using PCEA（bupivacaine300mg＋fentanyl 500μg＋250mL NS,4mL/h pumping）,while those in PCEA-parecoxib group were subjected to PCEA and parecoxib（40mg,iv,q12h×2d）.The visual analog scale（VAS）was used to assess the degree of the postoperative pain.The times of bowel flatus,mobilisation,catheter withdrawal and adverse effects were compared.Results：There was no statistical significance of static VAS scores of PCEA group at 1h、6h、12h、24、48hand 72 hafter surgery between two groups.The time of bowel flatus in PCEA-parecoxib group was（31±8.2）h,which was significantly shorter than that in PCEA group（[48±5.2]h,P〈0.001）.The time of mobilization in PCEA-parecoxib group was（18±8.2）h,which was also significantly shorter than that in PCEA group（[26±5.2]h,P〈0.001）.Similarly,the time of catheter withdrawal in PCEA-parecoxib group was（26±8.2）h,which was significantly shorter than that in PCEA group（[68±5.2]h,P〈0.001）.There were 2cases of nausea and vomiting and 1case of hypotension in PCEA group while 1case of nausea in PCEA-parecoxib group,and no incidence of hypotension.Conclusions：Analgesia using sequential PCEA-parecoxib combined with modified Joel-Cohen incision for laparoscopic left lateral hepatectomy is effective and equivalent to PCEA.It can facilitate a faster postoperative recovery and is worthy of wide application for laparoscopic left lateral hepatectomy.

关 键 词：腹腔镜肝左外叶切除术 镇痛 硬膜外患者自控镇痛 帕瑞昔布 

分 类 号：R614.42[医药卫生—麻醉学]