对乙酰氨基酚用于食管内镜黏膜下剥离术术后镇痛的有效性和安全性:一项前瞻性、随机、双盲、安慰剂对照试验  

Efficacy and safety of paracetamol for postoperative analgesia after esophageal endoscopic mucosal dissection:a prospective,randomized,double-blind,placebo-controlled trial

作　　者：邢文鑫 张宗旺[2] 赵同航[2] 武姗姗[2] 申文龙 路可欣 Xing Wenxin;Zhang Zongwang;Zhao Tonghang;Wu Shanshan;Shen Wenlong;Lu Kexin(Graduate Department,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250117,China;Department of Auesthesiology,Liaocheng People's Hospital,Liaocheng 252000,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)研究生部,济南250117 [2]聊城市人民医院麻醉科,聊城252000

出　　处：《国际麻醉学与复苏杂志》2025年第3期259-265,共7页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨手术结束前静脉注射对乙酰氨基酚用于食管内镜黏膜下剥离术(ESD)术后镇痛的有效性和安全性。方法选取2023年2月至2023年5月于聊城市人民医院择期在气管插管静吸复合全身麻醉下行食管ESD的患者78例,采用随机数字表法分为对乙酰氨基酚组(P组,38例)和对照组(C组,40例)。P组患者于手术结束前20 min静脉注射500 mg对乙酰氨基酚,C组患者给予等量0.9%氯化钠溶液。记录患者一般情况、既往史、术前诊断、手术时间、麻醉时间、术中用药、切除病变部位、切除病变面积、切除时间、止血时间以及组织学类型;记录患者离开麻醉后监测治疗室(PACU)即刻、术后2 h、术后6 h、术后24 h活动和静息视觉模拟评分法(VAS)疼痛评分;记录术后24 h血液白细胞计数及变化,术后24 h发热情况,术后恶心、呕吐或干呕、头晕发生率,出院时补救性镇痛药物使用情况以及术后出血、穿孔发生率。结果两组患者一般情况、既往史、术前诊断、手术时间、麻醉时间、术中用药、切除病变部位、切除病变面积、切除时间、止血时间及组织学类型差异无统计学意义(均P>0.05)。与C组比较,P组患者离开PACU即刻、术后2 h、术后6 h活动和静息VAS疼痛评分均降低(均P<0.05),但术后24 h活动和静息VAS疼痛评分差异无统计学意义(均P>0.05)。两组患者术后2、6 h活动和静息VAS疼痛评分高于离开PACU即刻和术后24 h(均P<0.05);术后2 h与术后6 h比较、离开PACU即刻与术后24 h比较,活动和静息VAS疼痛评分差异均无统计学意义(均P>0.05)。P组患者补救性镇痛药物使用率较C组低,但差异无统计学意义(P>0.05)。两组患者术后24 h血液白细胞计数及变化,术后24 h发热情况,术后恶心、呕吐或干呕、头晕发生率等差异无统计学意义(均P>0.05);两组患者均未发生术后出血和穿孔。结论手术结束前静脉注射对乙酰氨基酚可有效缓解食�Objective To evaluate the efficacy and safety of intravenous paracetamol administered before the end of surgery for postoperative analgesia in patients undergoing esophageal endoscopic mucosal dissection(ESD).Methods A total of 78 patients who underwent esophageal ESD under combined inhaled and intravenous general anesthesia with tracheal intubation at Liaocheng People's Hospital between February and May 2023 were included.According to the random number table method,the patients were divided into two groups:paracetamol(group P,n=38)and control(group C,n=40).Group P was intravenously injected with 500 mg of paracetamol 20 min before the end of surgery,while group C received the same amount of normal saline.Data recorded included general information,medical history,preoperative diagnosis,surgical duration,anesthesia duration,intraoperative medication,lesion location,lesion area,resection time,hemostasis time,and histological type.The Visual Analogue Scale(VAS)scores at rest and during exercises were recorded immediately after discharge from the post-anesthesia care unit(PACU),as well as 2 h,6 h and 24 h post-surgery.Furthermore,blood leukocyte counts and changes 24 h post-surgery,fever 24 post-surgery,the incidence of postoperative nausea,vomiting or retching,and dizziness,as well as use of rescue analgesic drugs at discharge,the incidence of postoperative hemorrhage and perforation were recorded.Results There were no statistical differences between the two groups in general information,medical history,preoperative diagnosis,surgical duration,anesthesia duration,intraoperative medication,lesion location,lesion area,resection time,hemostasis time,and histological type(all P>0.05).Compared with group C,group P showed decreases in VAS scores at rest and during exercises immediately after discharge from the PACU,as well as 2 h and 6 h post-surgery(all P<0.05),but there was no statistical difference in VAS scores at rest and during exercises 24 h post-surgery(all P>0.05).In both groups,VAS scores at rest and during exer

关 键 词：对乙酰氨基酚 内镜黏膜下剥离术 镇痛 

分 类 号：R614[医药卫生—麻醉学]