帕瑞昔布钠对腹腔镜辅助下胃癌手术患者血浆前列腺素E2水平及术后患者自控镇痛效果的影响

摘要

目的 观察帕瑞昔布钠对腹腔镜辅助下胃癌手术患者血浆前列腺素E2(PGE2)水平及术后患者自控镇痛(PCA)临床效果的影响.方法 选择接受术后静脉患者自控镇痛(PCIA)的腹腔镜辅助胃癌手术患者90例,随机分为对照组(S组)和帕瑞昔布钠组(P组),各45例.S组分别于手术前30 min及术后8h给予生理盐水5 ml,P组分别于手术前30 min及术后8h静脉注射帕瑞昔布钠40 mg.于术前30 min(T1)、手术开始后2 h(T2)和术后12 h(T3)采集患者中心静脉血检测血浆PGE2浓度.评估记录患者手术后12、24、48 h的静息和动态视觉模拟评分法(VAS)疼痛评分、PCA舒芬太尼消耗量及有效按压次数、相关不良反应及镇痛满意度评分.结果 与T1时比较,S组和P组T2时血浆PGE2水平均降低(P＜0.05),T3时血浆PGE2水平均升高(P＜0.05)；与S组比较,P组血浆PGE2水平T2时(135.95 ± 30.27比147.78±19.70)和T3时(168.03±29.15比182.61±28.36)显著降低(P＜0.05)；术后12 h时P、S组静息VAS疼痛评分分别为(12.73±12.41)分和(23.64±15.29)分(P＜0.05)；动态VAS评分分别为(13.18±13.14)分和(23.63±15.29)分(P＜0.05)；24 h时P、S组静息VAS疼痛评分分别为(l0.00±8.73)分和(17.27 ±9.84)分(P＜0.05)；动态VAS评分分别为(10.90±8.11)分和(17.27 ±9.84)分(P＜0.05)；PCA有效按压次数P组少于S组(P＜0.05)；两组相关不良反应发生率差异无统计学意义(P＞0.05)；P组镇痛满意程度高于S组(P＜0.05).结论 帕瑞昔布钠可显著抑制外周血浆PGE2的生成,有效改善腹腔镜辅助下胃癌手术患者术后自控镇痛的临床效果.%Objective To investigate the effect of parecoxib sodium on levels of prostaglandin E2 (PGE2) in plasm and patient-controlled analegsia (PCA) after laparoscopic gastrectomy.Methods Ninety gastric cancer patients scheduled for elective laparoscopic gastrectomy accepting PCA were randomly divided into 2 groups:control group (group S) and parecoxib sodium grou (group P).Group S received intravenous normal saline (5 ml) 30 min before incision and 8 h after operation respectively.Group P received intravenous parecoxib sodium (40 mg) 30 min before incision and 8 h after operation respectively.Venous blood samples were collected 30 min before incision (T1),2 h after surgery beginning (T2) and 12 h after operation (T3) to test PGE2 concentrations.The visual analogue scale (VAS) for assessing resting and motion pain at 12,24 and 48 h after operation,the consumption of sufentanil,effective number of PCA,the side effects and patient satisfaction were recorded.Results The levels of PGE2 were significantly lower at T2 in group S and group P than at T1 (P ＜ 0.05),higher at T3 (P ＜ 0.05).As compared with group S,the levels of PGE2 at T2(135.95 ± 30.27 vs.147.78 ± 19.70) and at T3 (168.03 ±29.15 vs.182.61 ± 28.36) were significantly lowered in group P (P ＜ 0.05).The resting VAS of pain at 12 h after operation in group P and group S was separately 12.73 ± 12.41 and 23.64 ± 15.29 (P ＜0.05),abd the motion VAS of pain was 13.18 ± 13.14 and 23.63 ± 15.29 (P ＜0.05).The resting VAS of pain at 24 h after operation in group P and group S was separately 10.00 ± 8.73 and 17.27 ± 9.84 (P ＜ 0.05),and the motion VAS of pain wase 10.90 ± 8.11 and 17.27 ± 9.844 (P ＜ 0.05).The effective number of PCA was significantly less in group P than in group S (P ＜ 0.05).No significant differences were found between two groups at the side effects (P ＞ 0.05).The patient satisfaction was better in group P than in group S (P ＜ 0.05).Conclusion Parecoxib sodium could siginificantly suppress the production of PGE2 and improve the effect of PCA after laparoscopic gastrectomy.