帕瑞昔布钠与地佐辛超前镇痛对乳腺癌根治术患者心血管反应及术后镇痛的影响

摘要

目的:比较帕瑞昔布钠和地佐辛超前镇痛对乳腺癌根治术患者心血管反应及术后镇痛的影响.方法:择期将全麻下行单侧乳腺癌根治术的患者90例,ASA分级Ⅰ-Ⅱ级,随机分为三组:P组(帕瑞昔布钠组)、D组(地佐辛组)和S组(生理盐水组即对照组),每组30例.三组均采用丙泊酚和瑞芬太尼静脉麻醉,在诱导前15min,P组和D组分别给予帕瑞昔布钠40mg、地佐辛5mg静脉注射作为超前镇痛,S组则给予等量(5ml)生理盐水；术后均采用芬太尼静脉自控镇痛(PCIA).记录三组患者入室安静后(T1)、麻醉诱导入睡后(T2)、插管后即刻(T3)、切皮后(T4)、手术结束时(T5)、拔除气管导管后即刻(T6)的平均动脉压(MAP)和心率(HR),记录术中丙泊酚和瑞芬太尼的用量,患者恢复情况及术后3h、6h、12h、24h和48h的疼痛视觉模拟评分(VAS),PCIA泵试图按压次数、有效按压次数,观察术后不良反应.结果:三组患者T3、T6时刻MAP和HR都明显升高,P组升幅最小,与S组和D组比较差异有统计学意义(P＜0.05)；S组术中异丙酚和瑞芬太尼的用量明显多于P组和D组(P＜0.05)；三组患者手术时间、苏醒时间、拔管时间和苏醒期躁动比较差异无统计学意义(P＞0.05)；P组术后VAS评分明显低于D组和S组(P＜0.05)；P组术后3h、6h、12hPCIA泵试图按压次数明显少于D组(P＜0.05).结论:帕瑞昔布钠与地佐辛超前镇痛都能有效抑制手术和插管刺激诱发的心血管反应,减轻术后疼痛,但帕瑞昔布钠的作用强于地佐辛.%Objective:To observe the impact of preemptive analgesia using Parecoxib Sodium and Dezocine on cardiovascular response and postoperative analgesia of radical mastectomy.Methods:All 90 patients undergoing elective radical mastectomy under general anesthesia were randomly divided into 3 groups:P group (Parecoxib sodium group),D group (Dezocine group)and S group (normal saline control group)30 patients in each group.Total intravenous anesthesia (TIVA) using propofol and remifental were applied in three groups.15 minutes before anesthesia induction,intravenous Parecoxib Sodium 40mg or Dezocine 5mg was given to patients in P group and D group respectively as preemptive analgesia,same volume (5ml) normal saline was given to patients in S group.Patient controlled intravenous analgesia(PCIA) using fentanyl was applied to patients as post-operative analgesia.HR and MAP were recorded at the time patients calming down after entering room(T1),after induction(T2),immediately after endotracheal intubation(T3),after skin cut(T4),at the end of the surgery(T5)and immediately after extubation(T6).Dose of propofol and remifental used during operation.Operating time,recovery time and extubation time were recorded.Postoperative pain was assessed using visual analog scales(VAS) at 3h,6h,12h,24h and 48h after surgery.Attempt PCIA number and effective press number were recorded.The adverse events were observed.Results:HR and MAP increased in three groups at T3 and T6 with significant difference between S group,D group and P group (P ＜ 0.05).Dose of propofol and remifental used in S group was more than that in P group and D group (P ＜ 0.05).VAS in P group was lower significantly than in D and S group(P ＜0.05).Attempt PCIA number in P group was less than that in D group at 3h,6h and 12h after surgery (P ＜ 0.05).Conclusion:Used as Preemptive analgesia for radical mastectomy,both Parecoxib Sodium and Dezocine can reduce cardiovascular response caused by intubation and operation stimulation,decrease postoperative pain.Parecoxib Sodium is more effective than Dezocine.