摘要
目的研究帕瑞昔布钠超前镇痛对开胸手术患者术后镇痛效果和应激反应的影响。方法根据美国麻醉师协会(ASA)分级标准,选择ASAⅠ～Ⅱ级择期行全麻下开胸手术患者60例,随机分为帕瑞昔布钠组和对照组。两组患者均采用布托啡诺行自控静脉镇痛,帕瑞昔布钠组于术前30min、术毕即刻、术后24h、术后36h分别静脉注射帕瑞昔布钠40mg;对照组在各时点给予生理盐水5mL。两组均于麻醉前(T0)、术后2h(T1)、12h(T2)、24h(T3)、48h(T4)抽取静脉血,用放免法测定血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度,于术后T1～T4记录视觉模拟镇痛评分(VAS)。采用t检验和重复测量方差分析法进行统计学分析。结果帕瑞昔布钠组VAS于术后T2、T3、T4明显低于对照组(P<0.05);帕瑞昔布钠组血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇浓度于术后T2、T3、T4与T0比较,差异无统计学意义(P>0.05),而对照组各指标术后T2、T3较T0明显增高,差异有统计学意义(P<0.05);帕瑞昔布钠组与对照组比较各项指标在术后T2、T3显著降低,差异有统计学意义(P<0.05)。结论帕瑞昔布钠超前镇痛模式可以有效完善患者开胸术后静脉自控镇痛效果,并可抑制术后机体应激反应,对缓解开胸手术患者术后免疫损伤和炎症反应有一定帮助。
Objective To investigate the effect of parecoxib sodium preemptive analgesia on postoperative an algesia and stress response in the patients undergoing thoracotomy. Methods According to American Society of An esthesiologists（ASA） grade, 60 patients with ASA Ⅰ-Ⅱ undergoing thoracotomy were selected and randomly divid- ed into 2 groups：the parecoxib sodium group （n=30） and the control group（n = 30）. All patients received patient- controlled intravenous analgesia （PCIA） with butorphanol. In the parecoxib sodium group, 40mg parecoxib sodium was administered at 30 min before operation,the end of the surgery and 24h and 36h after surgery. The control group received intravenous normal saline 5mL at the same time points. Renin activity,angiotensin,aldosterone and cortisol in plasma in each group were measured immediately before induction of anesthesia（T0） and at 2 h（T1）, 12 h（T2） ,24 h（T3） and 48 h（T4） after operation. The analgesic effect assessed by visual analog scale（VAS） at T1 ,T2,T3 and T4. Repeated measures analysis of variance and t test were used for statistic analysis. Results The VAS pain scores in the parecoxib sodium group were significantly lower than those in the control group at T2,T3 and T4, respectively （P〈0.05）. There was no significant difference in the concentrations of plasma rennin activity,angiotensin,aldoste- rone and cortisol at T2,T3,and T4 compared to TO in the parecoxib sodium group（P〉0.05）, while the concentrations of plasma rennin activity,angiotensin,aldosterone and cortisol at T2, T3 were significantly increased compared to TO in the control group（P〈0.05）. The concentrations of plasma rennin activity, angiotensin, aldosterone and cor- tisol at T2 and T3 were significantly lower in the parecoxib sodium group than in the control group,with statistical difference between the two groups（P〈0.05）. Conclusion Pareeoxib has a good postoperative analgesic effect, and can effectively prevent stress response,which is useful in relieving postoperative immunolesion and inflammatory reaction for the patients undergoing thoracotomy.
出处
《检验医学与临床》
CAS
2011年第17期2065-2067,共3页
Laboratory Medicine and Clinic
