帕瑞昔布钠术前给药对腹腔镜胆囊切除术患者应激反应及PONV评分的影响  

Effects of preoperative administration of parecoxib sodium on stress reaction and postoperative nausea and vomiting score in patients undergoing laparoscopic cholecystectomy

作　　者：汤旭丽 黎红玮[1] 郑碧莲 王芳[3] Tang Xuli;Li Hongwei;Zheng Bilian;Wang Fang(Department of Hepatobiliary and Pancreatic Surgery,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Neurosurgery,Lishui City People's Hospital,Lishui 323000,Zhejiang Province,China;Department of Surgery,The Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310051,Zhejiang Province,China)

机构地区：[1]丽水市人民医院肝胆胰外科,丽水323000 [2]丽水市人民医院神经外科,丽水323000 [3]浙江大学医学院附属儿童医院外科,杭州310051

出　　处：《中国基层医药》2022年第10期1485-1489,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省科技厅科技计划项目 (LY19H050036)。

摘　　要：目的观察帕瑞昔布钠术前给药对腹腔镜胆囊切除术(LC)患者应激反应及术后恶心呕吐(PONV)评分的影响。方法选取丽水市人民医院2020年1月至2021年1月行腹腔镜胆囊切除术患者112例为研究对象,采用随机数字表法分为观察组、对照组,每组56例。观察组术前30 min静脉注射帕瑞昔布钠40 mg,对照组于术前30 min静脉注射等量0.9%氯化钠注射液。比较两组术后1 h、6 h、12 h、24 h视觉模拟评分法(VAS)评分、皮质醇(COR)和促肾上腺皮质激素(ACTH)水平及PONV发生情况。结果观察组,VAS评分术后1 h[(3.23±0.85)分]、6 h[(2.44±0.76)分]、12 h[(2.37±0.69)分]均明显低于对照组[(4.06±1.12)分、(3.24±0.95)分、(3.10±1.07)分](t=4.41、4.92、4.29,均P<0.001);COR术后1 h[(287.79±35.46)ng/L]、6 h[(303.55±34.77)ng/L]、12 h[(368.58±31.22)ng/L]、24 h[(397.16±32.60)ng/L]均明显低于对照组[(337.64±39.52)ng/L、(364.18±36.90)ng/L、(405.56±37.29)ng/L、(455.51±37.81)ng/L](t=7.02、8.94、5.69、8.74,均P<0.05);ACTH水平术后1 h[(59.25±7.63)ng/L]、6 h[(65.27±8.23)ng/L]、12 h[(72.29±7.49)ng/L]、24 h[(83.63±8.57)ng/L]均明显低于对照组[(64.48±8.06)ng/L、(71.44±8.59)ng/L、(79.79±8.15)ng/L、(90.08±8.26)ng/L](t=3.52、3.88、5.07、4.05,均P<0.05);术后24 h内,观察组PONV发生率[12.50%(7/56)]明显低于对照组[28.57%(16/56)](χ^(2)=4.43,P<0.05),术后2 h内[(1.31±0.26)分]、2~6 h[(1.43±0.32)分]、>6~24 h[(1.46±0.41)分]PONV评分均明显低于对照组[(1.67±0.41)分、(1.83±0.39)分、(1.88±0.44)分](t=2.12、2.37、2.14,均P<0.05)。结论帕瑞昔布钠术前给药对LC患者术后镇痛效果良好,可有效降低其术后应激反应和PONV发生率,减轻PONV程度,可在临床广泛应用。Objective To investigate the effects of preoperative administration of parecoxib sodium on stress reaction and postoperative nausea and vomiting score in patients undergoing laparoscopic cholecystectomy.Methods A total of 112 patients undergoing laparoscopic cholecystectomy in Lishui City People's Hospital from January 2020 to January 2021 were included in this study.They were randomly divided into observation group and control group,with 56 patients per group.The observation group was intravenously administered 40 mg parecoxib sodium 30 minutes before surgery,and the control group was identically administered equal amount of 0.9%sodium chloride injection.At 1,6,12 and 24 hours after surgery,Visual Analogue Scale(VAS)score,cortisol and adrenocorticotropic hormone levels and postoperative nausea and vomiting score were compared between the two groups.Results At 1,6 and 12 hours after surgery,VAS score in the observation group was(3.23±0.85)points,(2.44±0.76)points,(2.37±0.69)points,respectively,which were significantly lower than(4.06±1.12)points,(3.24±0.95)points,(3.10±1.07)points in the control group(t=4.41,4.92,4.29,all P<0.001).At 1,6,12 and 24 hours after surgery,cortisol level in the observation group was(287.79±35.46)ng/L,(303.55±34.77)ng/L,(368.58±31.22)ng/L,(397.16±32.60)ng/L,respectively,which were significantly lower than(337.64±39.52)ng/L,(364.18±36.90)ng/L,(405.56±37.29)ng/L,(455.51±37.81)ng/L in the control group(t=7.02,8.94,5.69,8.74,all P<0.05).At 1,6,12 and 24 hours after surgery,adrenocorticotropic hormone level in the observation group was(59.25±7.63)ng/L,(65.27±8.23)ng/L,(72.29±7.49)ng/L,(83.63±8.57)ng/L,which were significantly lower than(64.48±8.06)ng/L,(71.44±8.59)ng/L,(79.79±8.15)ng/L,(90.08±8.26)ng/L in the control group(t=3.52,3.88,5.07,4.05,all P<0.05).Within 24 hours after surgery,the incidence of postoperative nausea and vomiting in the observation group was significantly lower than that in the control group[12.50%(7/56)vs.28.57%(16/56),χ^(2)=4.43,P<0.05).Within

关 键 词：胆囊切除术 腹腔镜 环氧化酶2抑制剂 术前用药法 应激 疼痛测定 手术后恶心呕吐 镇痛 预后 自身免疫 

分 类 号：R657.4[医药卫生—外科学]