摘要
目的:探讨甲状腺手术患者分别应用帕瑞昔布钠与氟比洛芬酯的术后镇痛效果及对其血流动力学、炎性细胞因子的影响。方法:选取我院2014年6月~2016年11月收治并择期行甲状腺手术治疗的122例患者,依据随机数字表法均分为两组。观察组于手术结束前30 min缓慢静脉注射40 mg帕瑞昔布钠,对照组采用相同的方式注射50 mg氟比洛芬酯。记录比较两组术后各时点Ramsay镇静评分(RSS)、视觉模拟评分(VAS),血流动力学指标,血清炎性细胞因子水平以及术后不良反应的发生情况。结果:两组患者术后均可获得较为理想的镇静镇痛效果,两组术后2、4、6 h的RSS、VAS组间相比差异均无统计学意义(P>0.05)。与对照组同期对比,观察组术后12、24 h的RSS、VAS,均显著更优(P<0.01)。两组麻醉诱导前(T0)、术毕(T1)、术后12 h(T2)、术后24 h(T3)的HR、MPA及SpO_2,组内及组间比较差异均无统计学意义(P>0.05)。与本组T0对比,两组T1、T2、T3的血清TNF-α、IL-6、hs-CRP水平,均显著上升(P<0.01);与本组T1相比,两组T2、T3的血清炎性细胞因子水平,均显著降低(P<0.01);两组各时点血清炎性细胞因子水平组间对比差异均无统计学意义(P>0.05)。观察组不良反应率为4.9%,较对照组(8.2%)对比差异无统计学意义(P>0.05)。结论:与氟比洛芬酯相比,甲状腺手术患者于手术结束前30 min应用帕瑞昔布钠在稳定血流动力学、控制术后炎症反应及安全性方面优势相当,但帕瑞昔布钠的镇静镇痛维持时间更长,术后镇痛效果更为理想。
Objectives：To explore the postoperative analgesic effect ofparecoxib sodium and flurbiprofen axetil for thyroid operation and their impact on the hemodynamics and inflammatory cytokines.Methods：122 cases of patients who receive thyroid operation in our hospital from June 2014 to November 2016 were selected and randomly divided into two groups.At 30 minutes before operation finishes,40mg parecoxib sodium was slowly injected intravenously to the patients in the observation group,and the control group was injected with 50mg flurbiprofen axetil in the same way.The Ramsey sedation score （RSS） and visual analogue score （VAS）,hemodynamic and inflammatory cytokines,postoperative adverse reaction at any postoperative time were recorded and compared between two groups.Results：Both groups received good sedation analgesic effect.No statistical difference was found in the RSS and VSA at 2nd,4th,6th postoperative hour between groups （P〉0.05）.The RSS and VAS at 12th and 24th postoperative hour in the observation group were significantly better than those of the control group at the same time point （P〈0.01）.The HR,MPA and SpO2 before anesthesia induction （T0）,when operation finish （T1）,at 12th postoperative hours （T2）,and 24th postoperative hours （T3） of both groups showed no statistical difference compared with the internal group or between groups （P〉0.05）.The serum TNF-α,IL-6 hs-CRP levels at T1,T2,T3 were significantly increased compared with those at T0 within the same group （P〈0.01）.The inflammatory cytokines level at T2,T3 were significantly de-creased compared with those at T1 within the same group （P〈0.01）.There was no statistical difference in the serum inflammatory cy-tokines levels between groups at any time point（P〉0.05）.There was no statistical difference in the incidence of adverse reactions between two groups （P〉0.05）.Conclusion：The application of parecoxib sodium and flurbiprofen axetil on patients with thyroid at 30 minutes before operation ends had similar effort on stabilizing the hemodynamics and controlling the postoperative inflammatory response and safety,but parecoxib sodium could provide longer sedation and analgesia time and better postoperative analgesic effect.
出处
《现代生物医学进展》
CAS
2017年第13期2459-2462,2494,共5页
Progress in Modern Biomedicine
基金
重庆市卫生局2012医学科研计划项目(2012-2-002)
关键词
帕瑞昔布钠
氟比洛芬酯
甲状腺手术
术后镇痛
血流动力学
炎性细胞因子
Parecoxib sodium
Flurbiprofen axetil
Thyroid operation
Postoperative analgesic
Hemodynamics
Inflammatory cytokines
