马敏,咸淑悦,王成夭
MA Min,XIAN Shuyue,WANG Chengyao

• 1:武汉大学中南医院麻醉科

摘要(Abstract)：

目的:观察帕瑞昔布钠对全麻腹部肿瘤术后的镇痛效果。方法:行全麻腹部肿瘤手术45例,随机平均分为3组,Ⅰ组在手术开始前30 min静脉注射帕瑞昔布40 mg,Ⅱ组在手术结束前30 min静脉注射帕瑞昔布40 mg,Ⅲ组为对照组不给予帕瑞昔布镇痛,3组病人手术结束前45 min均给予负荷量地佐辛0.05 mg/kg,术后均予地佐辛自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)持续镇痛48 h,PCIA配方中地佐辛剂量为0.75 mg/kg;观察3组患者术后0.25 h、2 h、4 h、8 h及24 h的视觉模拟评分(visual analoguescale,VAS),0.25 h的Remesay镇静评分,术后PCIA总使用次数,观察术后48 h内恶心、呕吐、尿潴留、出血、皮肤瘙痒、发热等不良反应。结果:术后0.25 h、2 h,Ⅰ组VAS评分显著高于Ⅱ组,差异有统计学意义(P<0.05);术后24 h内各时点,Ⅲ组的VAS评分显著高于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05);术后0.25 h,Ⅰ组和Ⅱ组的Remesay镇静评分显著高于Ⅲ组;术后48 hⅢ组的PCIA使用次数显著高于Ⅰ组和Ⅱ组;Ⅲ组患者术后恶心、呕吐、发热、尿潴留的发生率明显高于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05)。结论:帕瑞昔布钠用于全麻腹部肿瘤手术具有确切的术后镇痛效果,可显著减少地佐辛PCIA的按压次数,降低不良反应发生率。
Objective: To study the analgesic effects of parecoxib in patients after abdominal cancer surgery with general anesthesia. Methods: Forty-five patients accepting abdominal cancer operation with general anesthesia were randomly divided into three groups( n = 15). All the patients in groupⅠ were given 40 mg parecoxib by intravenous injection in 30 min before the surgery,patients in groupⅡ received 40 mg parecoxib in 30 min before the end of the surgery; group Ⅲ was the control group. Every patient received a loading dose of 0. 05 mg / kg dezocine in 45 min before the end of the surgery, and patient-controlled intravenous analgesia( PCIA) with 0. 75 mg / kg dezocine was carried out after the operation. The visual analog scale( VAS) scores in 0. 25,2,4,8 and 24 h after operation and Remesay scores were recorded in 0. 25 h after operation. The number of using times of PCIA and adverse reactions,such as nausea,vomiting,urinary retention,bleeding,skin itching,fever and so on in 48h after operation were recorded. Results: VAS was significantly higher in group Ⅱthan that in groupⅠ( P < 0. 05) in 0. 25 h and 2 h after surgery; In 0. 25,2,4,8 and 24 h,VAS was significantly higher in group Ⅲ than that in groupⅠand group Ⅱ( P < 0. 05). Remesay score was significantly higher in groupⅠand group Ⅱthan that in group Ⅲ( P < 0. 05) at 0. 25 h and 2 h. The number of using times of PCIA was significantly higher in group Ⅲ than that in groupⅠand groupⅡ( P < 0. 05). The incidences of nausea,vomiting,urinary retention and fever in group Ⅲ were significantly more than those in groupⅠand group Ⅱ( P < 0. 05). Conclusions: Parecoxib has exact analgesic effects after abdominal cancer surgery with general anesthesia,which can reduce the number of using times of dezocine PCIA and adverse reaction rate.

关键词(KeyWords)： 帕瑞昔布;腹部肿瘤手术;术后镇痛;地佐辛
parecoxib;abdominal cancer surgery;postoperative analgesia;dezodine

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 马敏,咸淑悦,王成夭
MA Min,XIAN Shuyue,WANG Chengyao

DOI: 10.19367/j.cnki.1000-2707.2014.02.018

参考文献(References)：

• [1]曹建明,韩元福,张佳雷.帕瑞昔布钠对晚期癌症患者作用的研究[J].山西医药杂志,2012(4):409-410.
• [2]谢刚,蒋柯,刘艳秋.等.11 174例手术后患者在麻醉恢复室的监测治疗[J].贵阳医学院学报,2012(6):654-655.
• [3]周燕艳.术后急性疼痛治疗的新进展[J].临床药物治疗杂志,2012(5):35-38.
• [4]崔向丽,赵志刚,陈丽,等.新型注射用选择性COX-2抑制剂帕瑞昔布钠[J].中国新药杂志,2009(14):1283-1286.
• [5]张永宏,吴兴龙,周力.COX-2在Barrett食管中的表达及意义[J].贵阳医学院学报,2009(2):170-172.
• [6]Pham-Marcou TA,Beloeil H,Sun X,et al.Antinociceptive effect of resveratrol in carrageenan-evoked hyperalgesia in rats:prolonged effect related to COX-2 expression impairment[J].Pain,2008(2):274-283.
• [7]Talley JJ,Bertenshaw SR,Brown DL,et a1.N-[(5-methyl-3-phenylisoxazol-4-y1)-pheny1]sulfonyl propanamide,sodium salt,parecoxib sodium:A potent and selective inhibitor of COX-2 for parenteral administration[J].J Med Chem,2000(9):1661-1663.
• [8]杭黎华,邵东华,张庆喜,等.帕瑞昔布钠对瑞芬太尼致术后痛觉过敏的影响[J].临床麻醉学杂志,2012(8):733-735.
• [9]吴新民,岳云,张利萍,等.术后镇痛中帕瑞昔布钠对吗啡用量的节俭作用和安全性—前瞻性、多中心、随机、双盲、安慰剂对照、平行分组研究[J].中华麻醉学杂志,2007(1):7-l0.
• [10]岳修勤.地佐辛与芬太尼应用于术后静脉镇痛的临床效果比较[J].中国疼痛医学杂志,2010(4):255.
• [11]刘新伟.芬太尼与地佐辛在老年骨科病人镇痛的同时对老年病人循环和呼吸功能的影响的比较[J].现代预防医学,2011(23):4995-4996,4999.
• [12]高峰,杨辉,曹菲,等.不同药物治疗全麻患者苏醒期躁动的疗效比较[J].临床麻醉学杂志,2011(2):109-111.
• [13]Cheer SM,Goa KL.Parecoxib(parecoxib sodium)[J].Drugs,2001(8):1133-1141.

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