目的 采用随机、双盲、对照的方法观察帕瑞昔布对经蝶垂体瘤切除术术中七氟烷呼气末浓度和麻醉恢复的影响.方法 择期经蝶垂体瘤切除术患者60例随机分为帕瑞昔布组(P组,n=30 )和对照组(C组,n=30 ).芬太尼-丙泊酚-维库溴铵麻醉诱导插管.手术开始前1hP组和C组分别静脉滴注帕瑞昔布40mg(10ml)或生理盐水10ml.调节七氟烷吸入药浓度,维持MAP在基础MAP的80%～110%之间.记录术中七氟烷吸入和呼气末浓度、各观察时间点的血压和心率、术中总入液量、总出液量、出血量及尿量,观察术后呼之睁眼、指令运动、定向力恢复的时间、术后患者清醒时及术后4h的VAS评分以及麻醉恢复期不良反应.结果 P组患者的七氟烷呼气末浓度在术中各观察点均低于C组(P<0.05或P<0.01).从停止吸入麻醉到睁眼、指令运动、定向力恢复的时间P组较C组缩短(P均<0.01).术后清醒时及术后4h,P组患者的VAS评分低于C组(P<0.05或P<0.01).P组术后躁动的发生低于C组(P<0.05).结论 术前静注帕瑞昔布40mg能够显著减少经蝶垂体瘤切除术中七氟醚呼气末浓度,维持血流动力学平稳,缩短麻醉恢复时间,减少恢复期的不良反应.%Objective To investigate the effect of preoperative parecoxib( 40mg ) on end - tidal concentration of sevoflurane during pituitary adenomas resection and anesthetic recovery. Methods Sixty patients suffering from pituitary adenomas with ASA physical Ⅰ ～Ⅱ were randomly allocated into two groups to receive parecoxib 40mg i. v. ( Group P, n= 30 ) or placebo ( Group C, n= 30 ). The end -tidal concentration of sevoflurane was measured. BP, HR, the volumes of bleeding, transfusion, fluid infusion and urine were recorded.VAS ( 0= no pain, 10= worst pain ) awake, 4h after the operation were recorded. The times of consciousness recovery, following commands and orientation from general anesthesia, and side effects during recovery were observed. Results The end - tidal concentration of sevoflurane in group P was lower than that of group C( P ＜ 0.05 or P ＜ 0.01 ). The time of consciousness recovery, following commands and orientation in group P were significantly shorter than those in group C( P ＜ 0.01 ). The incidence of restlessness in group P was lower than that in group C( P ＜ 0.05 ). Conclusion The preoperative application of parecoxib ( 40mg ) before pituitary adenomas resection can reduce the end- tidal concentration of sevoflurane, smooth the recovery from anesthesia and decrease the side effect during recovery.
展开▼
