帕瑞昔布钠超前镇痛在异丙酚和瑞芬太尼靶控输注中的临床应用

摘要

目的 探讨帕瑞昔布钠超前镇痛在异丙酚和瑞芬太尼靶控输注静脉全身麻醉中的应用.方法 将100例实施妇科宫腔镜检手术患者随机分成A,B2组,2组的麻醉方式都为异丙酚、瑞芬太尼靶控输注静脉全身麻醉.A组为术前20 min静脉注射帕瑞昔布钠,B组为术前20 min静脉注射等量0.9％氯化钠溶液.观察患者术前和术中满足手术要求时的异丙酚和瑞芬太尼的靶控输注浓度,血压、心率、血氧饱和度,术后患者的镇痛效果VAS评分、镇静评分(Ramsay)、躁动评分(RS).结果A组患者的目标靶控浓度小于B组(P＜0.05)；术后患者镇痛效果评分A组优于B组(P＜0.05),躁动发生率B组明显高于A组(P＜0.05).2组的镇静评分差异无统计学意义(P＞0.05).结论 帕瑞昔布钠超前镇痛在异丙酚、瑞芬太尼靶控输注保留自主呼吸静脉全身麻醉中应用,可以减少二者的目标靶控浓度,提高术中患者的安全性,同时可以明显减少患者术后的烦躁,提供良好的镇痛,且没有阿片类药物样并发症的发生.%Objective To investigate the clinical application of parecbxib sodium preemptive analgesia in the propofol and remifentanil target controlled infusion. Methods. One' hundred female patients who received gynecological hysteroscopy examination in our hospital were randomly divided into group A and group B, the patients in both groups were anesthetized by general anesthesia of propofol and remifentanil target controlled venous infusion. The patients in group A were injected with parecoxib sodium at 20min before operation, however, the patients in group B were intravenously injected with equivalence 0. 9% NS 20min before operation. The concentration of propofol and remifentanil target controlled venous infusion before operation and during operation, patients' blood pressure,heart rate, blood oxygen saturation were detected and observed, and the analgesic effect VAS scoring,sedative scoring (Ramsay) .restlessness scoring ( RS) were recorded after the operation. Results The goal target controlled concentration in group A was significantly lower than that in group B ( P <0. 05) ,and analgesic effect VAS scoring after operation in group A was superior to that in group B ( P <0.05) .however,the incidence of restlessness in group B was significantly higher than that in group A ( P < 0. 05 ). There was no significant difference in the sedative scoring ( Ramsay ) between two groups ( P > 0. 05 ). Conclusion The clinical application of parecoxib sodium preemptive analgesia in the general anesthesia with reserving spontaneous breathing through propofol and remifentanil target controlled infusion can reduce the goal target controlled concentration of both drugs and increase safety during the operation, meanwhile, parecoxib sodium can decrease obviously patients' postoperative restlessness, which has satisfactory analgesic effect, without the occurrence of complications including conscious sedation, respiratory depression, vomiting caused by opioids drugs.