帕瑞昔布钠术前给药对老年患者腰方肌阻滞联合全麻腹腔镜结肠癌根治术的影响  

Effect of Preoperative Administration of Parecoxib Sodium on Quadratus Lumborum Block Combined with General Anesthesia for Laparoscopic Radical Resection of Colon Cancer in Elderly Patients

作　　者：李冉 蒋亚坤 张占军[1] LI Ran;JIANG Ya-kun;ZHANG Zhan-jun(Anesthesia Surgery Center,Jiaozuo People's Hospital,Jiaozuo,Henan 454000)

机构地区：[1]焦作市人民医院麻醉手术中心,河南焦作454000

出　　处：《中国肛肠病杂志》2023年第11期30-33,共4页Chinese Journal of Coloproctology

摘　　要：目的:探讨帕瑞昔布钠术前给药对老年患者腰方肌阻滞(QLB)联合全麻腹腔镜结肠癌根治术的影响。方法:选择2021年1月至2022年12月择期于QLB联合全麻下行腹腔镜结肠癌根治术治疗的60例老年患者,随机数字表法分为观察组和对照组,各30例。观察组麻醉前30 min予帕瑞昔布钠40 mg静脉注射,对照组予0.9%氯化钠注射液5 mL静脉注射。比较2组手术情况、麻醉药用量,术前、切皮后15 min、术毕时心率(HR)及平均动脉压(MAP),术前、切皮后15 min、术毕、术后6 h血浆皮质醇(Cor)水平,术后12 h、24 h、36 h、48 h疼痛程度(VAS评分),术后第1天和第2天蒙特利尔认知评估量表(MoCA)评分,以及不良反应。结果:2组手术时间、术中出血量、术中丙泊酚及瑞芬太尼用量比较差异均无统计学意义,P>0.05;观察组术后舒芬太尼用量少于对照组,P<0.05。2组患者术前、切皮后15min、术毕HR及MAP相对稳定,无明显变化,P>0.05。2组患者术前、切皮后15 min、术毕、术后6 h血浆Cor水平均先升高后降低,但观察组各时点波动较小(P>0.05),对照组各时点血浆Cor水平波动较大(P<0.05);组间比较,切皮后15 min、术毕时观察组血浆Cor水平明显低于对照组,P<0.05。观察组术后12 h VAS评分低于对照组(P<0.05),其他时点2组间无明显差异(P>0.05)。术后第1天和第2天,观察组MoCA评分均高于对照组(P<0.05)。观察组不良反应发生率略低于对照组,但差异无统计学意义(P>0.05)。结论:老年患者腰方肌阻滞联合全麻腹腔镜结肠癌根治术前静脉注射帕瑞昔布钠,可减少阿片类镇痛药用量,降低手术引发的应激反应,改善患者术后认知功能,值得临床推广应用。Objective To investigate the effect of preoperative administration of Parecoxib Sodium on quadratus lumborum block(QLB)combined with general anesthesia for laparoscopic radical resection of colon cancer in elderly patients.MethodsFrom January 2021 to December 2022,total 60 elderly patients who underwent QLB combined with general anesthesia for laparoscopic radical resection of colon cancer were selected and divided into the observation group and the control group with 30 cases in each group by random number table method.The observation group was intravenously injected 40 mg Parecoxib Sodium 30 min before anesthesia,and the control group was intravenously injected 5 ml 0.9%sodium chloride.The operation status,anesthetic dosage,heart rate(HR)and mean arterial pressure(MAP)before operation,15 min after incision and after operation,plasma cortisol(Cor)level before operation,15 min after incision,after operation and 6 h after operation,pain levels 12 h,24 h,36 h and 48 h after operation(VAS scores),Montreal Cognitive Assessment Scale(MoCA)scores on the first and second day after operation,and adverse reactions were compared between the two groups.ResultsThere were no significant differences in the operation time,intraoperative blood loss,intraoperative dosage of Propofol and Remifentanil between the two groups(P>0.05).The dosage of Sufentanil in the observation group was lower than that in the control group(P<0.05).HR and MAP in the two groups were relatively stable before operation,15 min after incision and after operation,with no significant changes(P>0.05).Plasma Cor levels in the two groups were firstly increased and then decreased before operation,15 min after incision,after operation and 6 h after operation,but the fluctuations at each time points in the observation group were low(P>0.05),while those in the control group were high(P<0.05).The plasma Cor levels in the observation group were significantly lower than those in the control group 15 min after incision and after operation(P<0.05).The VAS score of the o

关 键 词：帕瑞昔布钠 腰方肌阻滞 结肠癌 腹腔镜手术 麻醉 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]