比较术前和术中静脉注射帕瑞昔布钠对开胸术后芬太尼静脉自控镇痛的影响

摘要

目的 评价帕瑞昔布钠对开胸术后芬太尼静脉自控镇痛(PCIA)的效果及安全性.方法 60例ASA Ⅰ或Ⅱ级择期开胸手术患者随机均分为三组:Ⅰ组于切皮前15 min静脉注射帕瑞昔布钠40 mg;Ⅱ组于缝皮时静脉注射帕瑞昔布钠40 mg;Ⅲ组为空白对照组.术后均采用芬太尼PCIA镇痛.记录术后2、8、24、48 h的HR、MAP、疼痛VAS评分及不良反应;记录术后24 h内PCIA的芬太尼用量.结果 Ⅰ、Ⅱ组8、24 h VAS评分显著低于Ⅲ组(P<0.05);术后24 h芬太尼用量Ⅰ组[(0.53±0.02)mg]、Ⅱ组[(0.55±0.01)mg]明显低于Ⅲ组[(0.72±0.02)mg](P<0.05);Ⅰ、Ⅱ组不良反应发生率明显少于Ⅲ组(P<0.05).结论 帕瑞昔布钠可增强芬太尼术后镇痛效果降低不良反应发生率,不影响心血管功能,可安全用于开胸手术围术期辅助镇痛.%Objective To evaluate the analgesic effect and safety of parecoxib sodium on postoperative patient-controlled intravenous analgesia (PCIA) with fentanyl after thoracic surgery.Methods Sixty patients with ASA Ⅰ or Ⅱ undergoing thoracic surgery were randomly divided into three groups with 20 cases each. Group Ⅰ received parecoxib sodium 40 mg 15 min before operation, and group Ⅱ received parecoxib sodium 40 mg at the time of skin suture, and group Ⅲ received saline. PCIA with fentanyl was given to all patients. The scorings of VAS pain, HR, MAP at 2, 8, 24, 48 h after surgery,24 h fentanyl consumption and side effects were recorded. Results The VAS scorings of pain in the groups Ⅰ and Ⅱ were lower than those in the group Ⅲ at 8 and 24 h (P＜0.05). The 24 h fentanyl consumption in the group Ⅱ [ (0. 53 ±0. 02)mg] and group Ⅱ [ (0.55±0.01 )mg] were significantly lower than the group Ⅲ [(0. 72±0. 02)mg] (P＜0. 05). The overall incidence of side effects in the group Ⅰ and group Ⅱ were significantly lower than those of group Ⅲ (P ＜ 0. 05). Conclusion Parecoxib sodium can improve the outcomes of PCIA with fentanyl and reduce the incidence of postoperative adverse reactions without affecting cardiovascular function, and can be used safely for thoracic surgery.