目的：观察帕瑞昔布钠复合罗哌卡因局部伤口持续镇痛用于开胸手术后的镇痛效果。方法：择期开胸非心脏手术患者60例，ASAⅠ-Ⅱ级，随机均分为两组：帕瑞昔布钠组（ P 组）和对照组（ C组）。 P组于术毕前10 min、术后12、24、36 h静脉注射帕瑞昔布钠40 mg，C组在4个时间点均注射生理盐水。两组患者术后均行罗哌卡因局部伤口皮下持续输注镇痛，患者缝合切口前于皮下放置镇痛泵导管，继之通过导管快速给予0．5％罗哌卡因5 mL，此后术毕48h内以2 mL/h持续输注0．5％罗哌卡因。分别记录患者术后2、8、12、24、36、48 h 安静和翻身活动时的VAS评分、阿片类用量、副作用、住院时间及总体满意率等。结果：两组患者术后各时点安静和翻身活动时VAS评分差异均有统计学意义（P＜0．05），且观察不良反应在嗜睡、头晕、恶心呕吐、呼吸抑制等方面无统计学差异（P＞0．05），患者总体满意度和术后补充镇痛方面有明显差异（ P＜0．05）。结论：帕瑞昔布钠复合罗哌卡因局部伤口持续镇痛安全有效且明显降低哌替啶的用量、增加患者的满意度。%Objective:To observe the analgesia effect of parecoxib combined with ropivacaine local con-tinuous incision infusion after thoracotomy surgery .Method:Sixty patients with ASAⅠorⅡscheduled for se-lective non-cardiac thoracotomy surgery were randomly divided into parecoxib combined with ropivacaine lo-cal continuous incision infusion analgesia group ( group P ) and control group ( group C ) .The group P re-ceived intravenous parecoxib 40mg at 10min before the end of surgery , 12, 24 and 36h postoperatively , but the group C merely received equal volume of saline .The patients in both groups received local anesthetic in-filtrating catheter before incision suture .They received a bolus of 5mL 0.5%ropivacaine followed by 2mL/h 0.5%ropivacaine for 48 hours.Visual analogue scores (VAS) of rest pain and motion pain, opioid consump-tions, adverse effects, hospital stays and overall satisfaction at 2, 8, 12, 24, 36, 48h after the surgery were all recorded respectively .Result:There were significant differences in the VAS scores at rest or motion , over-all satisfaction rate , supplementary postoperative opoids consumption between the two groups ( P<0.05 ) , however, there were no significant differences in drowsiness , dizziness, nausea, vomiting, respiratory de-pression between the two groups ( P>0.05).Conclusion:Parecoxib combined with ropivacaine local contin-uous incision infusion after thoracotomy surgery is a safe and effective analgesic means , which can obviously reduce the amount of pethidine and increase overall satisfaction .
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