帕瑞昔布超前镇痛对胆囊切除术麻醉的影响

郭兴彩++赵怀金

[摘要] 目的 对帕瑞昔布超前镇痛对瑞芬太尼全凭静脉麻醉腹腔镜胆囊切除术的麻醉用量及术后疼痛的影响进行分析探讨。 方法 将该院2014年1—12月收治的93例患者随机分为I组（对照组）、II组（超前镇痛用药）及III组（术后用药镇痛），每组31例患者，对比3组患者的疼痛程度、血浆P物质（substance P）、白细胞介素6（IL-6）及不良反应发生率。结果 3组患者术后12 h及24 h的VAS评分均明显低于术后1 h，差异有统计学意义（P<0.05）。II组患者术后阿片类药物使用率明显少于I组及III组（P<0.05）。手术结束后及术后24 h，II组患者的IL-6水平明显低于I组及III组（P<0.05）。3组患者手术前后的血浆P物质浓度及不良反应发生率差异无统计学意义（P>0.05）。 结论 对腹腔镜胆囊切除术患者手术前静脉注射帕瑞昔布进行超前镇痛能有效减少术后阿片类药物用量，抑制患者体内的IL-6的释放，缓解患者疼痛，在临床上值得推广应用。

[关键词] 帕瑞昔布；瑞芬太尼；腹腔镜； 胆囊切除术

[中图分类号] R614 [文献标识码] A [文章编号] 1674-0742（2015）09（a）-0001-03

The Effect of Preemptive Analgesia with Parecoxib on the Anesthesia of Cholecystectomy

GUO Xing-cai， ZHAO Huai-jin

Anesthesiology Department， Tengnan Hospital， Shandong Energy Zaozhuang Mining Group， Jining， Shandong Province， 277606 China

[Abstract] Objective To study the dosage of preemptive analgesia with Parecoxib and its effect on postoperative pain in patients undergoing laparoscopic cholecystectomy with total intravenenous anesthesia. Methods Ninety-three cases admitted in our hospital from January 2014 to December 2014 were randomly divided into group I （control group）， group II treated by drugs for preemptive analgesia and group III treated by drugs for postoperative analgesia with 31 cases in each. The pain degree， plasma substance P， interleukin 6（IL-6） and incidence of side effects were compared between the three groups. Results The VAS score in the 3 groups at 12 hours and 24 hours after operation were much lower than those at 1 hour after operation， P<0.05. The postoperative opioid drugs use rate was obviously lower in group II than that in group I and group III， P<0.05. The IL-6 level was much lower in group II than that in group I and group III at the end of surgery and at 24h after surgery， P<0.05. The difference in the plasma substance P between the 3 groups before and after operation was not statistically significant， P>0.05. No statistically significant difference was found in the incidence of side effects between the 3 groups， P>0.05. Conclusion For patients undergoing laparoscopic cholecystectomy， intravenous injection of Parecoxib before the surgery for preemptive analgesia can effectively reduce the dosage of opioid drugs used after surgery， inhibit the release of IL-6 and alleviate the pain， so it is worthy of clinical application and promotion.

[Key words] Parecoxib； Remifentanil； Laparoscope； Cholecystotomy

麻醉可以使患者在手术过程中完全无痛，但是术后还是会出现疼痛困扰。虽然，术后镇痛能够为患者缓解痛苦，但是疼痛治疗情况仍然不太理想，约有80%患者术后会出现不同程度的疼痛[1]。帕瑞昔布钠是静脉用的COX-2抑制剂，具有镇痛、消炎作用，且对肠胃功能及血小板功能的影响小。临床上关于帕瑞昔布在腹腔镜胆囊切除术后镇痛虽多篇报道，但是在超前镇痛中的应用效果还有较大争议[2]。为了对帕瑞昔布超前镇痛对腹腔镜胆囊切除术中的应用价值进行分析探讨，该研究对该院2014年1—12月收治的93例腹腔镜胆囊切除术患者进行随机对照研究，现报道如下。