摘要
目的探讨帕瑞昔布应用于腹腔镜辅助胃癌围手术期的镇痛效果,以减少阿片类药物的用量及减少术后不良反应。方法回顾性分析本院自2016年5月-2018年3月期间行腹腔镜辅助胃癌根治术的患者临床资料135例,其中帕瑞昔布组纳入72例,麻醉诱导前20 min静脉输注帕瑞昔布40 mg,术后每12 h静脉注射注帕瑞昔布40 mg。而对照组63例,围手术期未使用帕瑞昔布。所有患者术后48 h内皆通过镇痛泵给予阿片类药物镇痛,当疼痛评分在4以上时,追加阿片类药物。采用视觉模拟评分法(visual analogue scale,VAS)对围手术期患者每天进行疼痛评估(0分为无痛,(l^3)分为轻度疼痛,(4~6)分为中度疼痛,(7~9)分为重度疼痛,10分为极重度疼痛)。记录术前、术后6 h、术后第(1~5)d每日早晨的静息状态、咳嗽、运动时VAS、阿片类药物使用剂量及不良反应、术后住院时间。结果帕瑞昔布组的视觉模拟评分在休息、咳嗽和活动后均低于对照组,且具有统计学差异(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。帕瑞昔布组术后住院时间短于对照组[(8.0±1.1)d比(9.1±1.4)d,P<0.05]。术后第1 d,帕瑞昔布组阿片类药物用量明显低于实验组0 mg(0,7.5),术后5 d,吗啡总用量明显低于帕瑞息布组。结论帕瑞昔布在腹腔镜辅助胃癌根治术围手术期的应用,可提高静息状态、咳嗽和活动时的镇痛效果,减少阿片类药物的用量、缩短住院时间。
Objective To investigate the analgesic effect of parecoxib application oflaparoscopic assisted radical gastrectomyduring perioperative periodtherefore,toreduce opioid dose and adverse reactions.Method 135 cases of laparoscopic assisted radical gastrectomy between May 2016 and March 2018 were analyzed retrospectively.Among them,72 patients in the parecoxib group received intravenous infusion of parecoxib 40 mg 20 minutes before anesthesia induction,and intravenous injection of parecoxib 40 mg every 12 hours after surgery.There were 63 cases in the control group,and no parecoxib was used during the perioperative period.The patients in the two groups were given opioid analgesics through the patient-controlled analgesia pump within 48 hours after operation,and opioids were added when the pain score was above 4.A visual analogue scale(VAS)was used to assess pain of perioperative patients every day.(0 score was divided into no pain,l^3 score was divided into mild pain,4 to 6 score was divided into moderate pain,7 to 9 score was divided into severe pain,and 10 was divided into extremely severe pain).Resting state,coughing,VAS during exercise,dose of opioids,adverse reactions,and postoperative hospital stay before surgery,6 hours after surgery,and 1-5 days after surgery were recorded.Result The visual analogue scale of parecoxib group was lower than that of the control group after taking rest,having cough and doing some activities(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The postoperative hospitalization time in parecoxib group(8.0±1.1 d)was shorter than that in the control group(9.1±1.4 d,P<0.05).At the first day after operation,the dosage of opioid drugs in pararecoxib group was significantly lower than that of the experimental group(0,7.5),and the total dosage of morphine was significantly lower than the pararecoxib group at 5 days after the operation.Conclusion The application of parecoxib in the perioperative period of laparoscopic radical gastrectomy can improve the analgesic effect when patients were being resting state,doing cough and doing some activities,which can reduce the dosage of opioid drugs and the time of hospitalization.
作者
袁传威
闫振
张谦
莫合买提.叶海亚
斯坎德尔.努尔买买提
李涛
YUAN Chuan wei;YAN Zhen;ZHANG Qian;Mo he mai ti·YE HAI YA;Si kan de er·NU ER MAI MAI TI;LI Tao(Department of Gastrointestinal Surgery,People's Hospital of XinjiangUygur Autonomous Region,Urumqi,830000)
出处
《新疆医学》
2019年第1期35-38,共4页
Xinjiang Medical Journal
关键词
胃肿瘤
疼痛管理
围手术期
帕瑞昔布
Stomach neoplasms
Pain management
Perioperative period
Pareeoxib
