帕瑞昔布超前镇痛在肝射频消融中的应用:倾向匹配分析  

Application of parecoxib preanalgesia in liver radiofrequency ablation:A propensity score matching analysis

作　　者：陈健聪[1] 赖佳明[1] 王炯亮 周仲国[2] Chen Jiancong;Lai Jiaming;Wang Jiongliang;Zhou Zhongguo(Department of Pancreato-Biliary Surgery,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Hepatic Surgery,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学附属第一医院胆胰外科,广州510080 [2]中山大学肿瘤防治中心肝脏外科,广州510060

出　　处：《中华普通外科学文献（电子版）》2021年第6期442-446,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省基础与应用基础研究基金项目(2020A1515110485);中山大学肿瘤防治中心临床医学科学家基金资助项目(16zxqk04)。

摘　　要：目的探讨选择性环氧合酶2抑制剂帕瑞昔布在肝脏射频消融术(RFA)中的超前镇痛作用。方法回顾性分析2015年4月至2016年1月中山大学肿瘤防治中心共188例(其中原发癌122例,转移灶66例)行RFA治疗患者的临床资料,分为帕瑞昔布组和对照组。帕瑞昔布组在术前30 min和术后每12小时均给药40 mg帕瑞昔布,且连续给药2 d,对照组则未做给药处理,倾向性评分匹配评估围手术期应用帕瑞昔布能否对患者在疼痛、呕吐、发热、炎症反应、术后住院时间等方面产生获益。结果经过倾向性评分匹配分析在两组中匹配44对患者,帕瑞昔布组术后当天和术后第1天的VAS疼痛评分较对照组显著降低(P<0.001、0.001),同时丙氨酸氨基转移酶和C反应蛋白水平也较对照组低,分别为[(177.0±88.0)mmol/L vs(327.7±387.1)mmol/L,P=0.043(;20.0±29.0)mg/L vs(49.7±44.1)mg/L,P<0.001]。结论帕瑞昔布可显著减轻RFA患者术后疼痛和炎性反应,加速患者术后康复。Objective To investigate the preanalgesic effect of selective cyclooxygenase-2 inhibitor parecoxib after liver radiofrequency ablation(RFA).Methods The clinical data of 188 cases of liver cancer(including 122 primary cancers and 66 metastases)receiving radiofrequency ablation in Sun Yat-sen University Cancer Center from April 2015 to January 2016 were retrospectively analyzed,and they were divided into the parecoxib group and control group.Parecoxib group was given 40 mg parecoxib 30 min before surgery and every 12 hours after surgery for 2 consecutive days,while the control group was not given the medication,to evaluate whether perioperative application of parecoxib would benefit patients in terms of pain,vomiting,fever,inflammatory response,postoperative hospital stay and other aspects.Results We matched 44 pairs of patients in the two study groups by propensity-score matching analysis.And further data analysis showed a significant reduction in VAS scores on the day after surgery and the first day after surgery in the parecoxib group(P<0.001,0.001,respectively).The serum levels of alanine aminotransferase and C-reactive protein were also lower than those in the control group[(177.0±88.0)mmol/L vs(327.7±387.1)mmol/L,P=0.043;(20.0±29.0)mg/L vs(49.7±44.1)mg/L,P<0.001],respectively.Conclusion Parecoxib can significantly reduce postoperative pain and inflammation in patients with RFA,thus accelerating postoperative recovery.

关 键 词：镇痛 疼痛 视觉模拟评分 快速康复外科 帕瑞昔布 

分 类 号：R735.7[医药卫生—肿瘤]