枸橼酸芬太尼联合帕瑞昔布钠在椎间孔镜手术中的镇痛、镇静效果  

Analgesic and sedative effects of Fentanyl Citrate combined with Parecoxib Sodium anesthesia in procedure of intervertebral foraminoscopy

作　　者：刘波[1] 叶泳均 王泽波[1] 张志海[1] 谢霞[1] LIU Bo;YE Yongjun;WANG Zebo;ZHANG Zhihai;XIE Xia(Department of Pain,Dongguan Fifth People′s Hospital(Dongguan Hospital Affiliated to Jinan University Medical School),Guangdong Province,Dongguan 523900,China)

机构地区：[1]广东省东莞市第五人民医院(暨南大学医学院附属东莞医院)疼痛科,广东东莞523900

出　　处：《中国医药导报》2018年第22期99-102,共4页China Medical Herald

基　　金：广东省东莞市科学技术局资助项目(2015105101095)

摘　　要：目的探讨椎间孔镜手术(PTED)采用枸橼酸芬太尼和帕瑞昔布钠联合应用对患者躁动情况、疼痛以及镇静效果的影响。方法选取2016年1~12月东莞市第五人民医院疼痛科收治的采用经皮椎间孔镜手术治疗的患者78例作为研究对象,随机分为两组:对照组39例患者取枸橼酸芬太尼50μg用生理盐水稀释至5 mL于术前约20 min时静脉滴注;观察组39例患者术前肌注帕瑞昔布钠40 mg,术中穿刺针抵达纤维环时取枸橼酸芬太尼(50μg)稀释至5 mL椎管注射麻醉。分别在麻醉前(T_0)、导针穿刺皮肤时(T_1)、纤维环扩孔开窗时(T_2)、髓核取出时(T_3)、射频消融治疗时(T_4)5个时段记录两组患者血压水平、心率变化情况;分别使用Ramsay镇静评分量表、视觉模拟评分(VAS)量表评估两组患者术中各时段疼痛程度和镇静状态。结果两组患者麻醉前血压水平、心率差异无统计学意义(P>0.05);T_1~T_4时观察组患者血压、心率较T_0时有所波动,但接近正常值,对照组患者血压、心率显著升高,组间数据差异有统计学意义(P<0.05)。术中除T_0时,其他各时段观察组患者VAS评分均低于对照组,而Ramsay评分均高于对照组,差异均有统计学意义(P<0.05)。结论在椎间孔镜手术时采用枸橼酸芬太尼联合帕瑞昔布钠椎管注射麻醉可稳定患者血压、心率等体征指标,术中镇痛、镇静效果显著,因此值得推广使用。Objective To probe into the influence of Fentanyl Citrate combined with Parecoxib Sodium anesthesia for percutaneous transforaminal endoscopic discectomy(PTED)in patients with restlessness,pain and sedative effects.Methods A total of 78 patients treated with percutaneous transforaminal endoscopic surgery in Department of Pain of Dongguan Fifth People′s Hospital from January to December in 2016 were selected as study objects,and they were divided into two groups by random method,39 patients of the control group were taken Fentanyl Citrate 50μg diluted with normal saline to 5 mL in preoperative intravenous infusion of about 20 min,while 39 patients of the observation group were taken preoperative intramuscular injection of Parecoxib Sodium 40 mg,and were taken the Fentanyl Citrate(50 g)diluted to 5 mL spinal injection anesthesia when the puncture needle reaches the fiber ring during the operation,and the changes of blood pressure and heart rate(HR)index of patients of two groups were recorded before anesthesia(T0),guided needle puncture(T1),annulus fibrosus fenestration(T2),nucleus pulposus removal(T3)and radiofrequency ablation(T4).And the degree of pain and the state of sedation during each period during the operation of patients in the two groups were evaluated by the Ramsay sedation rating scale and visual analogue scale(VAS).Results There was no significant difference in the blood pressure and HR before anesthesia between the two groups(P>0.05).At T1-T4,the blood pressure and HR in the observation group were fluctuated with more than T0,but closed to the normal value,the blood pressure and HR in the control group significantly increased,and the difference between the two groups was statistically significant(P<0.05).In each period except T0,VAS of patients in the observation group was lower,and Ramsay was higher than that of the control group,and the differences were statistically significant(P<0.05).Conclusion The Fentanyl Citrate combined with Parecoxib Sodium anesthesia in application of percutaneous tra

关 键 词：芬太尼 环加氧酶抑制药 清醒镇静 镇痛 椎间孔镜 

分 类 号：R971.2[医药卫生—药品]