帕瑞昔布三剂法不同用药时机对胆囊结石术后镇痛的影响  

Influence of different time of administration of parecoxib in three doses method on postoperative analgesia of gallbladder stones

作　　者：鲁育民[1] 陈祝明 方剑[1] 开喆 LU Yu-min;CHEN Zhu-ming;FANG Jian;KAI Zhe(Department of Hepatobiliary Surgery,Anqing First People′s Hospital,Anqing Anhui 246000,China)

机构地区：[1]安徽省安庆市第一人民医院肝胆外科,246000

出　　处：《蚌埠医学院学报》2022年第6期730-734,共5页Journal of Bengbu Medical College

基　　金：安徽省医学会急诊临床研究项目(ky2018032)。

摘　　要：目的:探讨帕瑞昔布三剂法不同用药时机对胆囊结石术后镇痛的影响。方法:采用前瞻性随机对照研究方法选取152例胆囊结石病人,根据随机数字表法分为对照组和观察组,各76例。2组均行腹腔镜胆囊切除术治疗,术后对照组采用帕瑞昔布经验给药(术后常规给药1次40 mg,病人诉切口疼痛再给药1次,1 d总药量不超过80 mg),观察组采用帕瑞昔布三剂法(术后即刻、术后8 h、术后16 h分别给药1次,每次20 mg)进行术后镇痛。对比2组术前(T_(0))、术后3 h(T_(1))、术后9 h(T_(2))、术后18 h(T_(3))血清应激相关因子去甲肾上腺素(NE)、血糖(Glu)、皮质醇(Cor)水平,疼痛程度(VAS评分),镇静情况(Ramsay镇静评分),躁动情况(Riker-SAS躁动评分),认知功能(MMSE评分),不良反应发生情况(恶心、皮肤瘙痒、呕吐、胃肠胀气、注射部位水肿),术后无痛下床时间、吗啡用量、住院时间以及住院总费用和病人满意度。结果:T_(1)、T_(2)、T_(3)时,2组血清NE、Glu、Cor水平均较T0时升高(P<0.05),但观察组均低于对照组(P<0.01)。T_(1)、T_(2)、T_(3)时,观察组VAS评分均低于对照组(P<0.01);T_(1)、T_(2)时,观察组Ramsay镇静评分高于对照组,T_(3)时低于对照组,差异均有统计学意义(P<0.01)。T_(1)、T_(2)时,观察组Riker-SAS躁动评分低于对照组,T_(3)时高于对照组(P<0.01);观察组不良反应总发生率低于对照组(P<0.05);观察组术后无痛下床时间、住院时间均较对照组短,吗啡用量、住院总费用均较对照组少(P<0.01);观察组术后镇痛满意度高于对照组,差异具有统计学意义(P<0.05)。结论:帕瑞昔布三剂法能显著降低胆囊结石术后病人血清应激相关因子水平,改善镇痛镇静效果,降低不良反应发生率,促进病人术后恢复,且能减少吗啡用量及住院总费用,病人满意度高。Objective:To explore the effects of different time of administration of parecoxib three doses method on postoperative analgesia of gallbladder stones.Methods:One hundred and fifty-two patients with gallbladder stones were investigated using a prospective randomized controlled study,and divided into the control group and observation group according to random number table method(76 cases in each group).Two groups were treated with laparoscopic cholecystectomy.The control group was given parecoxib empirically for 40 mg once after surgery,the patients with incision pain were given the medicine one more time,and the total dose was not more than 80 mg a day.The observation group was given parecoxib three doses method after 0 h,8 h and 16 h of surgery,20 mg each time for postoperative analgesia.The serum stress-related factors norepinephrine(NE),blood glucose(Glu),cortisol(Cor),pain degree(VAS score),sedation[Ramsay sedation score,agitation(Riker-SAS agitation score),cognitive function(MMSE score)],incidence rates of adverse reactions(including nausea,pruritus,vomiting,flatulence,edema at injection site),postoperative painless time of getting out of bed,morphine dosage,length of hospital stay,total hospitalization cost and patient′s satisfaction between two groups before operation(T_(0)),and at postoperative 3 h(T_(1)),postoperative 9 h(T_(2))and postoperative 18 h(T_(3))were compared.Results:At T_(1),T_(2) and T_(3),the serum levels of NE,Glu and Cor in two groups were higher than those at T0(P<0.05),but those in observation group were lower than those in control group(P<0.01).The VAS scores in observation group at T_(1),T_(2) and T_(3) were lower than that in control group(P<0.01).At T_(1) and T_(2),the Ramsay sedation score in observation group was higher than that in control group,and lower than that at T_(3)(P<0.01).The Riker-SAS agitation score in observation group at T_(1) and T_(2) were lower than that in control group,and which in observation group at T_(3) was higher than that in control group(P<0.01).The to

关 键 词：术后镇痛 腹腔镜胆囊切除术 帕瑞昔布 

分 类 号：R614[医药卫生—麻醉学]