帕瑞昔布联合罗哌卡因在腹腔镜胆囊切除术后早期镇痛中的疗效  

Efficacy of parecoxib combined with ropivacaine in early analgesia after laparoscopic cholecystectomy

作　　者：邬杰忠 柯春连[1] 李宇翠 谭雷[2] 黄河[1] 熊志勇[1] 梁豪[1] 张鹏[1] 王庆亮[1] 许世磊[1] 林继宗[1] 胡昆鹏[1] 姚志成[1] 刘波[1] Wu Jiezhong;Ke Chunlian;Li Yucui;Tan Lei;Huang He;Xiong Zhiyong;Liang Hao;Zhang Peng;Wang Qingliang;Xu Shilei;Lin Jizong;Hu Kunpeng;Yao Zhicheng;Liu Bo(Department of General Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ultrasound,Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院岭南医院普通外科,广州510630 [2]中山大学附属第三医院岭南医院超声科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2022年第4期395-400,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81572726);广东省自然科学基金(2018A030313641)。

摘　　要：目的探讨帕瑞昔布联合罗哌卡因在腹腔镜胆囊切除术(LC)术后镇痛的安全性和疗效。方法本前瞻性研究对象为2020年7月至2021年6月在中山大学附属第三医院岭南医院行LC的100例胆囊良性疾病患者。患者均签署知情同意书,符合医学伦理学规定。其中男44例,女56例;年龄24~77岁,中位年龄43岁。采用随机数字表法将患者分为实验组与对照组,每组各50例。实验组术前10 min静注帕瑞昔布40 mg,手术结束缝皮前给予罗哌卡因皮下浸润麻醉;对照组给予同等容量生理盐水。记录患者术后疼痛视觉模拟评分(VAS)及镇痛药使用情况,观察围手术期情况及并发症发生情况等。结果实验组术后l、6、12 h静态VAS分别为(2.0±0.7)、(2.2±0.4)、(1.1±0.2)分,明显低于对照组的(3.7±0.4)、(3.6±0.4)、(2.2±0.3)分(t=-2.192,-2.257,-2.811;P<0.05)。实验组术后l、6、12、24 h动态VAS分别为(2.7±0.6)、(3.1±0.2)、(2.1±0.4)、(1.3±0.1)分,明显低于对照组的(4.4±0.4)、(4.7±0.4)、(3.2±0.3)、(2.5±0.2)分(t=-2.427,-3.424,-2.454,-4.417;P<0.05)。实验组术后首次下床时间为(8.5±0.5)h,明显早于对照组的(10.5±0.7)h(t=-2.307,P<0.05);住院时间为(5.3±0.3)d,明显短于对照组的(7.3±0.8)d(t=-2.292,P<0.05)。实验组术后使用镇痛药4例,明显少于对照组的13例(χ^(2)=5.740,P<0.05)。两组均无术后伤口感染、腹腔感染、腹腔出血、呼吸抑制等并发症发生。实验组术后12 h的WBC、C-反应蛋白和IL-6分别为(10.0±1.1)×10^(9)/L、(37.4±7.2)mg/L、(56.4±8.7)ng/L,明显低于对照组的(14.2±1.5)×10^(9)/L、(65.1±6.9)mg/L、(80.9±6.1)ng/L(t=-2.163,-2.778,-2.314;P<0.05)。结论帕瑞昔布联合罗哌卡因在LC术后早期镇痛中效果明显,可减轻应激反应,促进术后快速康复,是一种简单、安全、有效的术后镇痛方法。Objective To evaluate the safety and efficacy of parecoxib combined with ropivacaine in early analgesia after laparoscopic cholecystectomy(LC).Methods In this prospective study,100 patients with benign gallbladder diseases underwent LC in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from July 2020 to June 2021 were recruited.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,44 patients were male and 56 female,aged from 24 to 77 years,with a median age of 43 years.All patients were divided into the study group(n=50)and control group(n=50)according to the random number table method.Patients in the study group were given intravenous injection of 40 mg parecoxib at 10 min before surgery,and subcutaneous infiltration anesthesia of ropivacaine was delivered before suturing.In the control group,an equivalent quantity of normal saline was delivered.The visual analogue scale(VAS)score of postoperative pain and use of analgesics were recorded.The perioperative conditions and complications was observed.Results In the study group,the static VAS scores at postoperative 1,6 and 12 h were 2.0±0.7,2.2±0.4 and 1.1±0.2,significantly lower than 3.7±0.4,3.6±0.4 and 2.2±0.3 in the control group(t=-2.192,-2.257,-2.811;P<0.05).At l,6,12 and 24 h after operation,the dynamic VAS scores in the study group were 2.7±0.6,3.1±0.2,2.1±0.4 and 1.3±0.1,significantly lower than 4.4±0.4,4.7±0.4,3.2±0.3 and 2.5±0.2 in the control group(t=-2.427,-3.424,-2.454,-4.417;P<0.05).The first off-bed activity time in the study group was(8.5±0.5)h,significantly earlier than(10.5±0.7)h in the control group(t=-2.307,P<0.05).In the study group,the length of hospital stay was(5.3±0.3)d,significantly shorter than(7.3±0.8)d in the control group(t=-2.292,P<0.05).In the study group,analgesics were used in 4 cases after operation,significantly less than 13 cases in the control group(χ^(2)=5.740,P<0.05).No postoperative wound infection,abdominal infection,a

关 键 词：胆囊切除术 腹腔镜 镇痛 麻醉药 全身 麻醉药 局部 帕瑞昔布 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]