基于术后疼痛及应激介质分泌研究帕瑞昔布钠超前镇痛用于腹腔镜手术的价值  

Study on the value of parecoxib sodium preemptive analgesia for laparoscopic surgery based on postoperative pain and stress mediator secretion

作　　者：韩庆波[1] 李永敏 刘洋[1] 郭平选[1] HAN Qing-bo;LI Yong-min;LIU Yang;GUO Ping-xuan(Anesthesiology Department, Kailuan General Hospital of Tangshan Hebei Province, Tangshan, Hebei Province, 063000 China)

机构地区：[1]河北省唐山市开滦总医院麻醉科,河北唐山063000

出　　处：《海南医学院学报》2020年第8期598-601,共4页Journal of Hainan Medical University

基　　金：河北省卫生和计划委员会2016年度重点科技研究计划(182497-2)。

摘　　要：目的:探讨帕瑞昔布钠超前镇痛用于腹腔镜手术对患者术后疼痛及应激反应的影响。方法:2018年1月~2019年1月间在本院进行择期腹腔镜手术治疗的无症状胆囊息肉患者118例,随机分为常规组、超前镇痛组各59例。对照组接受常规全凭静脉麻醉,超前镇痛组在麻醉诱导时静脉推注帕瑞昔布钠0.7 mg/kg。对比两组术前(T0)、拔管后30 min(T1)、术后6 h(T2)、术后24 h(T3)血清疼痛介质[前列腺素E2(PGE2)、P物质(SP)、神经肽Y(NPY)]、炎症因子[白介素-1β(IL-1β)、白介素-6(IL-6)、白介素-12(IL-12)]、应激介质[皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]水平的差异。结果:T0时,两组VAS评分值、炎症因子及应激介质水平比较,差异均无统计学意义(P>0.05)。T1、T2、T3时,超前镇痛组VAS评分值低于对照组;血清IL-1β、IL-6、IL-12、TNF-α的水平低于对照组;血清Cor、NE、E的水平低于对照组(P<0.05)。结论:腹腔镜胆囊切除术患者接受帕瑞昔布钠超前镇痛,对减少术后疼痛及全身应激状态具有积极作用。Objective To investigate the effect of parecoxib sodium preemptive analgesia on postoperative pain and stress response in patients with laparoscopic surgery.Methods Totally 118 patients with asymptomatic gallbladder polyps who underwent elective laparoscopic surgery in our hospital between January 2018 and January 2019 were divided into the control group(n=59)and the preemptive analgesia group(n=59)by random number table.Control group received routine total intravenous anesthesia,and preemptive analgesia group received intravenous injection of parecoxib sodium 0.7 mg/kg during anesthesia induction.The differences in serum levels of pain mediators prostaglandin E2(PGE2),substance P(SP)and neuropeptide Y(NPY),inflammatory factors interleukin-1β(IL-1β),interleukin-6(IL-6)and interleukin-12(IL-12)as well as stress mediators cortisol(Cor),norepinephrine(NE)and epinephrine(E)at the time points of before surgery(T0),30 min after extubation(T1),6 h after surgery(T2)and 24 h after surgery(T3)were compared between the two groups of patients.Results At T0,there was no significant difference in VAS score as well as inflammatory factor or stress mediator levels between the two groups(P>0.05).At T1,T2 and T3,VAS scores of the preemptive analgesia group were lower than those of the control group;serum IL-1β,IL-6,IL-12 and TNF-αlevels were lower than those of the control group;serum Cor,NE and E levels were lower than those of the control group(P<0.05).Conclusion Parecoxib sodium preemptive analgesia has a positive effect on reducing postoperative pain and systemic stress in patients with laparoscopic cholecystectomy.

关 键 词：腹腔镜手术 帕瑞昔布钠 超前镇痛 疼痛 应激介质 

分 类 号：R614[医药卫生—麻醉学]