帕瑞昔布超前镇痛联合胸段硬膜外镇痛在食管癌根治术患者中的应用  

Application of Preemptive Analgesia with Parecoxib Combined with Thoracic Epidural Analgesia in Patients Undergoing Radical Surgery of Esophageal Cancer

作　　者：史亚荣 曾毅 吴志新 SHI Ya-rong;ZENG Yi;WU Zhi-xin(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Military Medical University of PLA Air Force,Xi'an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院麻醉与围术期医学科,西安710032

出　　处：《解放军医药杂志》2020年第11期21-25,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：国家自然科学基金青年项目(81701207)。

摘　　要：目的探讨帕瑞昔布超前镇痛联合胸段硬膜外镇痛在食管癌根治术患者中的应用价值。方法选取本院2017年2月-2018年11月行食管癌根治术患者90例,按照麻醉前诱导用药不同分为观察组与对照组,每组45例。麻醉诱导前30 min,观察组给予帕瑞昔布40 mg静脉注射,对照组给予等量生理盐水静脉注射;2组术后均给予自控镇痛泵。对比2组入室后静卧5 min(T0)、注射即刻(T1)、插管前(T2)、插管后(T3)、手术切皮时(T4)、手术结束后(T5)时的心率(HR)与平均动脉压(MAP)。观察并比较2组术后2 h(T6)、术后12 h(T7)、术后24 h(T8)、术后48 h(T9)的视觉模拟评分法(VAS)、T淋巴细胞亚群水平及术后舒芬太尼用量、苏醒时间、不良反应发生情况。结果2组T0、T1、T2、T3、T4、T5时HR、MAP水平比较差异无统计学意义(P>0.05)。观察组T6、T7、T8时VAS评分低于对照组(P<0.05),但2组T9时VAS评分比较差异无统计学意义(P>0.05)。观察组T8、T9时术后舒芬太尼用量均少于对照组(P<0.05)。观察组T6、T7、T8、T9时CD4+、CD4+/CD8+水平高于对照组(P<0.05),2组T6、T7、T8、T9时CD8+水平比较差异无统计学意义(P>0.05)。2组意识恢复时间、自主呼吸恢复时间、清醒时间、拔管时间及不良反应发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠超前镇痛可产生明显的术后镇痛作用,保护机体免疫功能,不增加术毕患者苏醒时间,安全性较高。Objective To explore application value of preemptive analgesia with Parecoxib combined with thoracic epidural analgesia(TEA)in patients undergoing radical surgery of esophageal cancer.Methods Ninety patients with esophageal cancer undergoing radical surgery in our hospital from February 2017 to November 2018 were selected and divided into observation group(n=45)and control group(n=45)according to different induction drugs before anesthesia.The observation group was given Parecoxib 40 mg intravenously 30 min before anesthesia induction,and the control group was given the same amount of normal saline by injection.All patients were given patient controlled analgesia(PCA)after surgery.At 5 min after entering to room for reposing(T0),immediately after Parecoxib or normal saline injection(T1),before intubation(T2),after intubation(T3),at the time of surgical skin incision(T4)and after surgery(T5),levels of heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups.At 2h after surgery(T6),12h after surgery(T7),24h after surgery(T8)and 48h after surgery(T9),scores of visual analogue scale(VAS),levels of T lymphocyte subsets,dosage of Sufentanil,recovery time and occurrence of adverse reactions were compared between the two groups.Results There was no significant difference in HR and MAP between the two groups at T0,T1,T2,T3,T4 and T5(P>0.05).The VAS score of the observation group at T6,T7 and T8 was lower than that of the control group(P<0.05),but there was no significant difference in VAS score between the two groups at T9(P>0.05).The dosage of Sufentanil in the observation group was less than that in the control group at T8 and T9(P<0.05).The levels of CD4+and CD4+/CD8+at T6,T7,T8 and T9 in group A were higher than those in group B(P<0.05).There was no significant difference in the levels of CD8+at T6,T7,T8 and T9 between the two groups(P>0.05),and There was no significant difference in consciousness recovery time,spontaneous breathing recovery time,awakening time,extubation time and incidence of

关 键 词：食管肿瘤 食管癌根治术 胸段硬膜外镇痛 帕瑞昔布 T淋巴细胞亚群 疼痛 手术后 

分 类 号：R735.1[医药卫生—肿瘤]