选择性环氧化酶-2抑制剂在肝内外胆管结石患者围术期疼痛管理中的应用  

The effect of selective cyclooxygenase-2 ( COX-2) inhibitor in patients with intrahepatic and extrahepatic bile duct stones undergoing enhanced recovery after surgery

作　　者：冯金华[1] 李卡[2] 韩蔷[1] 高敏[1] 许瑞华[1] FENG Jin - hua;LI Ka;HAN Qiang;GAO Min;XU Rui -hua(Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Siehuan, China)

机构地区：[1]四川大学华西医院胆道外科,四川成都610041 [2]四川大学华西医院护理部,四川成都610041

出　　处：《广东医学》2018年第11期1726-1730,共5页Guangdong Medical Journal

基　　金：四川大学华西医院学科卓越发展1.3.5工程项目(编号:ZY2016204)

摘　　要：目的探讨加速康复外科理念下选择性环氧化酶-2(COX-2)在肝内外胆管结石患者围术期超前按需镇痛中的应用效果。方法回顾性分析胆道外科收治的196例应用选择性COX-2抑制剂超前镇痛的肝内外胆管患者(新型镇痛组)和188例应用地佐辛进行术后镇痛的肝内外胆管结石患者(地佐辛组)的临床资料。两组患者术中麻醉方案一致,术后采用相同的疼痛解救方案;对比分析两组患者围术期疼痛数字评分法(NRS)疼痛评分,疼痛解救药物使用率,镇痛不良反应发生率,镇痛满意度及住院时间。结果新型镇痛组患者术后2、12、24、72 h及术后7 d的NRS评分低于地佐辛组,差异均有统计学意义(P<0.05)。新型镇痛组的解救镇痛药物使用率低于地佐辛组(33.16%vs 54.26%),差异有统计学意义(P<0.05)。解救镇痛中,盐酸曲马多及盐酸哌替啶的使用率均低于地佐辛组,差异有统计学意义(P<0.05)。镇痛不良反应方面,新型镇痛组患者不良反应总发生率更少(14.29%vs 41.48%),差异有统计学意义(P<0.05)。新型镇痛组患者恶心、呕吐发生率低于地佐辛组,差异有统计学意义(P<0.05),其余各项并发症发生率差异无统计学意义(P>0.05)。新型镇痛组患者围术期的镇痛满意度高于地佐辛组,差异有统计学意义(P<0.05),两组患者住院时间和术后住院时间差异有统计学意义(P<0.05)。结论选择性COX-2抑制剂能有效降低肝内外胆管结石患者围术期的疼痛程度,减少解救镇痛药物的使用频率,降低不良反应发生率,缩短住院时间,提升患者满意度。Objective To investigate the effect of selective cyclooxygenase - 2 （ COX - 2 ） inhibitor in patients with intrahepatie and extrahepatic bile duct stones undergoing enhanced recovery after surgery （ERAS）. Methods A retrospective analysis of 206 patients with gallstones with COX - 2 inhibitor in the treatment of biliary surgery （ new analge- sia group）, and 198 patients treated with tramadol for postoperative analgesia with intrahepatic and extrahepatic bile duct stones （ digoxin group） during the same period were conducted. The patients in the two groups were treated with the same pain relief program. The NRS pain score, pain relief drug use rate, analgesic adverse reaction, analgesic satisfaction and hospital stay were compared between the two groups. Results The NRS scores at postoperative （POS） 2h and POS 12h, and on POS ld, POS 2d and POS 3d were significantly lower in new analgesia group than the digoxin group （P 〈0. 05）. The analgesic drug use rate in new analgesia group was significantly lower than that in digoxin group （33.16% vs. 54. 26% , P 〈 0. 05 ）. The rate of using tramadol hydrochloride and pethidine hydroehloride was significantly lower in new analgesia group than that of digoxin group （ P 〈 0. 05 ）. Tile incidence of adverse reactions was significantly lower in the new analgesia group （ 14. 29% vs. 41.48%, P 〈0. 05）. The incidence of nausea and vomiting was significantly lower in new analgesia group than digoxin group （ P 〈 0. 05 ）. The analgesia satisfaction of the patients in new analgesia group was significantly higher than that in digoxin group （ P 〈 0. 05 ）. There was no significant difference in the average hospital stay or postoperative hospital stay between the two groups （ P 〉 0.05 ）. Conclusion COX - 2 inhibitors can reduce the periop-erative pain in patients with intrahepatic and extrahepatic bile duct stones, reduce the frequency of the use of analgesic drugs, the incidence of adverse reactions and hospital stay, and improv

关 键 词：加速康复外科 肝内外胆管结石 选择性环氧化酶-2抑制剂 康复效果 

分 类 号：R614[医药卫生—麻醉学]