帕瑞昔布钠对烧伤患者全麻苏醒期寒战与躁动的影响

摘要

Objective: To investigate the effect of intravenous parecoxib sodium prior to the end of surgery on chills and restless during recovery from general anesthesia in burned patients. Method: Seventy patients, ASA Ⅱ-Ⅲ class, undergoing elective skin grafting surgery were randomly divided into two groups ( n =35 each group). The patients in control group (Con) and Parecoxib sodium group ( Par) received intravenous injection of Parecoxib sodium 40 mg (40 mg/2 mL) and saline 2 mL in the end of the wound dressing respectively. The time from completion of surgery to extubation, the shivering and chills grade, restlessness score (RS) , Ramesay sedation score (RSS) , and physical comfort score ( BCS) were recorded in the period of recovery from anesthesia. Result: The incidence of shivering ( grade 2 ) in control group was significantly greater than that in Par group, and the ratio of severe chills ( grade 3 ) was higher in control group than that in Par group. The incidence of restlessness of the control group ( 65.7％ ) was significantly higher than that of Par group (31.4％, P＜0.05). The ratio of patients with RSS for 1 in control group (65.7％ ) was significantly greater than that in Par group ( 31.4％ ). On the contrary, the patients with RSS for 2-3 in the control group were significantly less than that in Par group. The ratio of patients with BCS for 0 points in control group (65.7％ ) was significantly greater than that in Par group (31.4％) while BCS ≧ 1 ratio of patients in control group (34.3％) was significantly is less than in Par group (68.6％ ). Conclusion: Intravenous Parecoxib sodium prior to the end of surgery can play the analgesic effect, prevent chills, restlessness during post-anesthesia recovery period, and improve the patient＇s comfort and safety in burned patients.%目的:观察帕瑞昔布钠对烧伤病人全麻苏醒期寒战和躁动的影响.方法:选择70例ASA Ⅱ-Ⅲ级择期行切痂植皮术患者,随机分为对照组(Con)和帕瑞昔布钠组(Par),每组各35例,分别在植皮结束创面包扎前静脉注射帕瑞昔布钠40 mg (40 mg/2 mL)和生理盐水2 mL.记录术毕至拔管时间、苏醒期间发生寒战的例数和寒战评级、躁动评分(RS)、镇静评分(RSS)、拔管后10 min记录身体舒适度评分(BCS).结果:对照组2级以上寒战发生率(40.0%)明显大于帕瑞昔布钠组(17.1%),且严重寒战(3级)的比例也明显高于帕瑞昔布钠组.对照组躁动发生率为65.7%,明显高于帕瑞昔布钠组(31.4%,P<0.05).对照组RSS为1分病人的比率(65.7%)明显大于帕瑞昔布钠组(31.4%),相反对照组RSS为2-3分病人的比率(28.6%)明显小于帕瑞昔布钠组(60.0%);对照组病人BCS为0分的比率(65.7%)明显大于帕瑞昔布钠组(31.4%),而对照组舒适度评分≧1分病人的比率(34.3%)明显小于帕瑞昔布钠组(68.6%).结论:术毕前静脉注射帕瑞昔布钠可发挥镇痛作用,预防烧伤病人全麻后苏醒期寒战、躁动,提高病人的舒适度和安全性.