腹腔镜胆囊切除术后羟考酮联合帕瑞昔布钠镇痛效果评价
|
摘要
目的探讨羟考酮联合帕瑞昔布钠对腹腔镜胆囊切除术后镇痛效果及炎性反应、应激反应的影响。方法选取医院2015年4月至2018年3月收治的行腹腔镜胆囊切除术患者97例,根据随机数字表法分为对照组(48例)和研究组(49例)。对照组患者给予帕瑞昔布钠联合吗啡治疗,研究组患者给予羟考酮联合帕瑞昔布钠治疗。结果两组患者术后1 d(T1)、术后2 d(T2)的视觉模拟评分(VAS)均较术后即刻(T0)明显降低,且研究组显著低于对照组(P <0. 05);两组患者T1,T2时白细胞介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)均较T0时升高,且研究组显著低于对照组(P <0. 05);两组患者T1,T2时去甲肾上腺素(NE)、胰岛素(INS)、皮质醇(Cor)均较T0时升高,且研究组显著低于对照组(P <0. 05);研究组不良反应发生率为10. 20%(5/49),显著低于对照组的31. 25%(15/48,P <0. 05)。结论羟考酮联合帕瑞昔布钠对腹腔镜胆囊切除术后镇痛效果较佳,可显著降低炎性因子水平,减轻应激反应,同时安全性较好。
Objective To investigate the effect of oxycodone combined with parecoxib sodium on analgesia,inflammatory response and stress response after laparoscopic cholecystectomy. Methods Totally 97 patients underwent laparoscopic cholecystectomy admitted to our hospital from April 2015 to March 2018 were selected and divided into the control group( 48 cases) and the study group( 49 cases)according to the random number table method. The patients in the control group were treated with parecoxib sodium combined with morphine,while the patients in the study group were treated with oxycodone combined with parecoxib sodium. Results 1 day( T1) and 2 days( T2) after operation,the scores of visual analogue scale( VAS) in the two groups were significantly lower than those at immediately after operation( T0),and those in the study group were significantly lower than those in the control group( P < 0. 05). The levels of interleukin-6( IL-6),C-reactive protein( CRP) and tumor necrosis factor-α( TNF-α) in the two groups at T1 and T2 were higher than those at T0,the levels in the study group were significantly lower than those in the control group( P < 0. 05). The levels of norepinephrine( NE),insulin( INS) and cortisol( Cor) in the two groups at T1 and T2 were higher than those at T0,the levels in the study group were lower than those in the control group( P < 0. 05). The incidence rate of adverse reactions in the study group was 10. 20%( 5/49),which was significantly lower than 31. 25%( 15/48) in the control group( P < 0. 05). Conclusion Oxycodone combined with parecoxib sodium has good analgesic effect and safety after laparoscopic cholecystectomy,it can significantly reduce the levels of inflammatory factors and stress response.
Objective To investigate the effect of oxycodone combined with parecoxib sodium on analgesia,inflammatory response and stress response after laparoscopic cholecystectomy. Methods Totally 97 patients underwent laparoscopic cholecystectomy admitted to our hospital from April 2015 to March 2018 were selected and divided into the control group( 48 cases) and the study group( 49 cases)according to the random number table method. The patients in the control group were treated with parecoxib sodium combined with morphine,while the patients in the study group were treated with oxycodone combined with parecoxib sodium. Results 1 day( T1) and 2 days( T2) after operation,the scores of visual analogue scale( VAS) in the two groups were significantly lower than those at immediately after operation( T0),and those in the study group were significantly lower than those in the control group( P < 0. 05). The levels of interleukin-6( IL-6),C-reactive protein( CRP) and tumor necrosis factor-α( TNF-α) in the two groups at T1 and T2 were higher than those at T0,the levels in the study group were significantly lower than those in the control group( P < 0. 05). The levels of norepinephrine( NE),insulin( INS) and cortisol( Cor) in the two groups at T1 and T2 were higher than those at T0,the levels in the study group were lower than those in the control group( P < 0. 05). The incidence rate of adverse reactions in the study group was 10. 20%( 5/49),which was significantly lower than 31. 25%( 15/48) in the control group( P < 0. 05). Conclusion Oxycodone combined with parecoxib sodium has good analgesic effect and safety after laparoscopic cholecystectomy,it can significantly reduce the levels of inflammatory factors and stress response.
引文
[1]郭珊娜,段光友,王金韬,等.舒芬太尼配伍曲马多用于女性腹腔镜胆囊切除术和妇科腹腔镜手术术后自控静脉镇痛效果的比较[J].中华外科杂志,2015,53(2):150-154.
[2]李建玉,杨秀环,董文芳,等.右美托咪定对瑞芬太尼持续输注下腹腔镜胆囊切除术患者机械痛觉阈值的影响[J].实用医学杂志,2015,31(21):3574-3577.
[3] HWANG BY,KWON JY,KIM E,et al. Oxycodone vs. fentanyl patient-controlled analgesia after laparoscopic cholecystectomy[J].Int J Med Sci,2014,11(7):658-662.
[4]毕艳,肖庆华,杨丽,等.帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响[J].医学综述,2015,21(10):1890-1892.
[5]祖翠华.腹腔镜胆囊切除术前给予帕瑞昔布钠对患者苏醒期躁动、疼痛及血流动力学的影响[J].新乡医学院学报,2015,32(9):884-886.
[6]侯春光,徐磊.腹腔镜胆囊切除术后羟考酮联合帕瑞昔布钠的镇痛效果评价及对炎症应激反应的影响[J].海南医学院学报,2017,23(24):3393-3396.
[7] HUANG JM,LV ZT,ZHANG YN,et al. Efficacy and Safety of Postoperative Pain Relief by Parecoxib Injection after Laparoscopic Surgeries:A Systematic Review and Meta-analysis of Randomized Controlled Trials[J]. Pain Pract,2018,18(5):597-610.
[8]李青,付群,茆庆洪,等.右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响[J].临床麻醉学杂志,2014,30(10):1015-1017.
[9]罗思佳,李汉军.羟考酮联合帕瑞昔布钠对腹腔镜胆囊切除术后减轻疼痛的作用[J].中国现代普通外科进展,2017,20(10):814-815.
[10]胡建,许建峰,刘耿,等.不同剂量羟考酮术前用药对腹腔镜胆囊切除术后疼痛及炎症细胞因子的影响[J].临床麻醉学杂志,2015,31(10):941-944.
[11]张进法,刘玉钦,郭超,等.盐酸羟考酮注射液联合地佐辛对腹腔镜胆囊切除术患者的镇痛效果及安全性研究[J].中国临床药理学杂志,2016,32(15):1384-1386.
[12] LIN S,HUA J,XU B,et al. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy:a randomized controlled trial[J]. Int J Clin Exp Med,2015,8(8):13824-13829.
[13]李.芬太尼与羟考酮分别复合丙泊酚在宫腔镜手术中的麻醉效果比较[J].医学临床研究,2017,34(5):903-905.
[2]李建玉,杨秀环,董文芳,等.右美托咪定对瑞芬太尼持续输注下腹腔镜胆囊切除术患者机械痛觉阈值的影响[J].实用医学杂志,2015,31(21):3574-3577.
[3] HWANG BY,KWON JY,KIM E,et al. Oxycodone vs. fentanyl patient-controlled analgesia after laparoscopic cholecystectomy[J].Int J Med Sci,2014,11(7):658-662.
[4]毕艳,肖庆华,杨丽,等.帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响[J].医学综述,2015,21(10):1890-1892.
[5]祖翠华.腹腔镜胆囊切除术前给予帕瑞昔布钠对患者苏醒期躁动、疼痛及血流动力学的影响[J].新乡医学院学报,2015,32(9):884-886.
[6]侯春光,徐磊.腹腔镜胆囊切除术后羟考酮联合帕瑞昔布钠的镇痛效果评价及对炎症应激反应的影响[J].海南医学院学报,2017,23(24):3393-3396.
[7] HUANG JM,LV ZT,ZHANG YN,et al. Efficacy and Safety of Postoperative Pain Relief by Parecoxib Injection after Laparoscopic Surgeries:A Systematic Review and Meta-analysis of Randomized Controlled Trials[J]. Pain Pract,2018,18(5):597-610.
[8]李青,付群,茆庆洪,等.右美托咪定复合帕瑞昔布钠对腹腔镜胆囊切除术后疼痛的影响[J].临床麻醉学杂志,2014,30(10):1015-1017.
[9]罗思佳,李汉军.羟考酮联合帕瑞昔布钠对腹腔镜胆囊切除术后减轻疼痛的作用[J].中国现代普通外科进展,2017,20(10):814-815.
[10]胡建,许建峰,刘耿,等.不同剂量羟考酮术前用药对腹腔镜胆囊切除术后疼痛及炎症细胞因子的影响[J].临床麻醉学杂志,2015,31(10):941-944.
[11]张进法,刘玉钦,郭超,等.盐酸羟考酮注射液联合地佐辛对腹腔镜胆囊切除术患者的镇痛效果及安全性研究[J].中国临床药理学杂志,2016,32(15):1384-1386.
[12] LIN S,HUA J,XU B,et al. Comparison of bupivacaine and parecoxib for postoperative pain relief after laparoscopic cholecystectomy:a randomized controlled trial[J]. Int J Clin Exp Med,2015,8(8):13824-13829.
[13]李.芬太尼与羟考酮分别复合丙泊酚在宫腔镜手术中的麻醉效果比较[J].医学临床研究,2017,34(5):903-905.